原发性肝癌和肝血管瘤患者超声造影表现特点比较*

doi:10.3969/j.issn.1672-5069.2023.03.030

摘要/Abstract

摘要： 目的探讨超声造影(CEUS)鉴别肝细胞癌(HCC)与肝血管瘤(HH)的影像学特点。方法 2020年1月～2021年12月我院收治的肝占位性病变患者95例,经术后组织病理学检查诊断HCC者51例和HH者44例。所有患者均接受CEUS检查,比较两组常规超声表现及CEUS检测的增始时间(AT)、达峰时间(TTP)、峰值增强强度、增强速率和50％倾斜率,绘制受试者工作特征曲线(ROC)分析各指标判断肝占位性病变性质的的效能。结果常规超声检查HCC病灶表现为边界清晰、高回声、形态规则和内部回声均匀占比分别为19.6%、21.6%、17.7%和13.7%,显著低于HH病灶(分别为68.2%、65.9%、72.7%和75.0%,P<0.05),HCC病灶Ⅱ级和Ⅲ级血流信号分别为68.6%和17.7%,显著高于HH病灶的11.4%和4.6%(P<0.05);动脉相HCC病灶呈明显快速增强,肿瘤组织呈现高回声,HH病灶动脉相早期发生周边环状或斑点状强化,中心无强化,门静脉相和实质相呈向心性充填式增强,实质相肿瘤呈强回声,实质相后期肿瘤回声减弱,呈自周边向中心充填式增强;HCC组AT为(14.6±4.5)s,显著长于HH组【(11.4±3.3)s,P<0.05】,TTP为(36.8±9.7)s,显著短于HH组【(44.2±11.6) s,P<0.05】,峰值增强强度和50％倾斜率为(8.8±2.5)和(0.4±0.2),显著低于HH组【分别为(12.5±3.6)和(0.9±0.4),P<0.05】,增强速率为(0.8±0.3),显著高于HH组【(0.6±0.2),P<0.05】;ROC曲线分析显示,联合AT、TTP、峰值增强强度、增强速率和50％倾斜率诊断肝占位性病变性质的灵敏度为92.5％,特异度为77.4％。结论采用CEUS检查可帮助临床鉴别HCC与HH病灶,值得临床应用研究。

关键词: 原发性肝癌, 肝血管瘤, 超声造影, 增始时间, 达峰时间, 诊断 , ,

Abstract: Objective The aim of this study was to compare contrast-enhanced ultrasound (CEUS) manifestation differences in patients with hepatocellular carcinoma (HCC) and hepatic hemangioma (HH). Methods A retrospective analysis was performed on the clinical data of 95 patients with liver space-occupying lesions between January 2020 and December 2021, and all patients underwent hepatectomy, having pathologically confirmed diagnosis, e.g. HCC in 51 cases and HH in 44 cases. All patients underwent CEUS examination before operation, and the arrival time (AT), time to peak (TTP), peak enhancement intensity, enhancement rate and 50% gradient of slope were obtained and compared between the two groups. The diagnostic performance of CEUS for liver space-occupying lesions was analyzed by receiver operating characteristic (ROC) curves. Results The conventional ultrasonography showed that the percentages of clear edge, hyperecho, regular shape and even intratumor echo in cancerous foci were 19.6%, 21.6%, 17.7% and 13.7%, all significantly lower than 68.2%, 65.9%, 72.7% and 75.0%(P<0.05) in HH foci, and the grade Ⅱ and Ⅲ blood signals in cancerous lesions were 68.6% and 17.7%, both significantly higher than 11.4% and 4.6%(P<0.05) in HH lesions; the rapid enhancement and hyperechoic tumor tissues in arterial phase was found, while in HH foci, there was a peripheral slow enhancement in early arterial phase, a centripetal filling enhancement in portal phase and an increased enhancement in delayed phase; the AT in cancerous lesions was (14.6±4.5) s, much longer than [(11.4±3.3)s, P<0.05], and the TTP was (36.8±9.7) s, significantly shorter than [(44.2±11.6) s, P<0.05] in HH lesions, the peak enhancement intensity and 50% gradient of slope were (8.8±2.5) and (0.4±0.2), significantly lower than [(12.5±3.6) and (0.9±0.4), P<0.05] in HH lesions, and the enhancement velocity was (0.8±0.3), much higher than [(0.6±0.2), P<0.05] in HH lesions; the ROC analysis showed that the sensitivity and the specificity were 92.5％ and 77.4％, when the combination of the AT, TTP, peak enhancement intensity, enhancement velocity and 50％ gradient of slope was applied to predict the quality of the space-occupying lesions of liver. Conclusion There are some different features of CEUS manifestations, which might help effectively differentiate lesions of HCC and HH.

Key words: Hepatoma, Hepatic hemangioma, Contrast-enhanced ultrasound, Arrival time, Time to peak, Diagnosis

段海珊, 蒋黎, 田青青, 孔令军, 游忠岚, 何小勤. 原发性肝癌和肝血管瘤患者超声造影表现特点比较^*[J]. 实用肝脏病杂志, 2023, 26(3): 420-423.

Duan Haishan, Jiang Li, Tian Qingqing, et al.. Differential diagnosis of patients with hepatocellular carcinoma and hepatic hemangioma by contrast-enhanced ultrasonography[J]. Journal of Practical Hepatology, 2023, 26(3): 420-423.

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原发性肝癌和肝血管瘤患者超声造影表现特点比较^*

Differential diagnosis of patients with hepatocellular carcinoma and hepatic hemangioma by contrast-enhanced ultrasonography

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