术前Sonazoid超声造影评估肝细胞癌病理分化程度的价值

doi:10.11958/20231409

天津医药 ›› 2024, Vol. 52 ›› Issue (6): 658-662.doi: 10.11958/20231409

术前Sonazoid超声造影评估肝细胞癌病理分化程度的价值

刘小艳(), 卜锐(), 陆健斐, 丁昱, 张幸

昆明医科大学第二附属医院超声医学科（邮编650101）

收稿日期:2023-09-14 修回日期:2023-11-16 出版日期:2024-06-15 发布日期:2024-06-06
通讯作者: ^△E-mail：burui0703@163.com
作者简介:刘小艳（1989），女，主治医师，主要从事腹部器官超声诊断方面的研究。E-mail：873002564@qq.com
基金资助:
云南省科技厅-昆明医科大学应用基础研究联合专项(202201AY070001-126)

Value of Sonazoid contrast-enhanced ultrasound for preoperatively evaluating pathological grade of hepatocellular carcinoma

LIU Xiaoyan(), BU Rui(), LU Jianfei, DING Yu, ZHANG Xing

Department of Ultrasound, the Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China

Received:2023-09-14 Revised:2023-11-16 Published:2024-06-15 Online:2024-06-06
Contact: ^△E-mail: burui0703@163.com

刘小艳, 卜锐, 陆健斐, 丁昱, 张幸. 术前Sonazoid超声造影评估肝细胞癌病理分化程度的价值[J]. 天津医药, 2024, 52(6): 658-662.

LIU Xiaoyan, BU Rui, LU Jianfei, DING Yu, ZHANG Xing. Value of Sonazoid contrast-enhanced ultrasound for preoperatively evaluating pathological grade of hepatocellular carcinoma[J]. Tianjin Medical Journal, 2024, 52(6): 658-662.

摘要/Abstract

摘要：

目的分析肝细胞癌（HCC）Sonazoid超声造影（CEUS）的特点与病理分化程度的相关性。方法纳入行CEUS检查并经病理确诊为HCC的患者64例，共64个病灶，根据病理分化程度将其分为高、中、低分化组，分别为6、48和10例。比较不同病理分化程度HCC的CEUS动脉期增强形态、增强水平和增强模式。结果动脉期增强形态分为均匀增强和不均匀增强2种，低分化组所有病灶及58.3%中分化组病灶呈不均匀高增强；高分化组病灶可呈均匀高增强、均匀等增强和不均匀高增强3种表现。动脉期，所有中、低分组病灶和66.7%高分化组病灶呈高增强，不同分化程度HCC的增强水平差异有统计学意义（P<0.01）；门脉期，高、中、低分化组分别有16.7%、25.0%和70.0%的病灶消退成低增强，不同分化程度HCC的增强水平差异有统计学意义（P<0.05）；延迟期，75%中分化组病灶和所有低分化组病灶呈低增强，66.7%高分化组病灶呈等增强，不同分化程度HCC的增强水平差异有统计学意义（P<0.01）；Kupffer期，所有低分化组和95.8%中分化组病灶呈低增强，高分化组中仍有50%的病灶呈等增强，不同分化程度HCC的增强水平差异有统计学意义（P<0.01）。高分化组病灶表现为多种CEUS模式，中分化组病灶以“快进快退”、“快进慢退”为主，90.0%低分化组病灶呈“快进快退”模式，不同分化程度HCC的CEUS模式差异有统计学意义（P<0.01）。结论 Sonazoid-CEUS在评估HCC病理分化程度方面具有一定价值。

关键词: 肝肿瘤, 病理学, 造影剂, Sonazoid, 超声造影

Abstract:

Objective To analyze the correlation between the characteristics of Sonazoid contrast-enhanced ultrasound (CEUS) and pathological differentiation in hepatocellular carcinoma (HCC). Methods A total of 64 patients with HCC diagnosed pathologically by CEUS examination were included, and a total of 64 lesions were divided into the high, medium and low differentiation groups (6, 48 and 10 cases, respectively) according to the degree of pathological differentiation. The enhancement pattern, enhancement level and enhancement pattern of CEUS arterial stage in HCC with different pathological differentiation were compared. Results The enhancement pattern of arterial phase was divided into the uniform enhancement and the uneven enhancement. All lesions in the low differentiated group and 58.3% in the middle differentiated group showed uneven and high enhancement. In the highly differentiated group, lesions showed homogenous hyperintensification, homogenous isointensification and non-homogenous hyperintensification. At arterial stage, all lesions in the middle and low differentiated groups and 66.7% lesions in the highly differentiated group showed high enhancement, and the enhancement levels of HCC with different differentiation degrees were significantly different (P<0.01). At the portal stage, 16.7%, 25.0% and 70.0% lesions in the high, medium and low differentiated HCC groups subsided to low enhancement, and the enhancement levels of HCC with different differentiation degrees were significantly different (P<0.05). In the delayed stage, 75% lesions in the medium-differentiated group and all lesions in the low-differentiated group showed low enhancement, and 66.7% lesions in the highly differentiated group showed equal enhancement. Enhancement levels of HCC with different differentiation degrees were significantly different (P<0.01). At the Kupffer stage, all lesions in the low differentiated group and 95.8% of the moderately differentiated group showed low enhancement, while 50% lesions in the highly differentiated group still showed equal enhancement, and there were significant differences in the enhancement levels of HCC with different differentiation degrees (P<0.01). The highly differentiated group showed multiple CEUS patterns, the moderately differentiated group mainly showed "fast advance and fast retreat" and "fast advance and slow retreat" patterns, and 90.0% of the low differentiated group showed "fast advance and fast retreat" patterns. There were significant differences in CEUS patterns between HCC with different degrees of differentiation (P<0.01). Conclusion Sonazoid-CEUS has certain value in evaluating the differentiation degree of HCC.

Key words: liver neoplasms, pathology, contrast media, Sonazoid, contrast-enhanced ultrasound

中图分类号:

R735.7

图/表 5

表1 3组不同分化程度HCC病灶的CEUS增强水平比较 [例（%）]

Tab.1 Comparison of CEUS enhancement levels of HCC lesions between different differentiation degree groups

组别	n	动脉期			门脉期			延迟期			Kupffer期
组别	n	高增强	等增强	低增强	高增强	等增强	低增强	高增强	等增强	低增强	高增强	等增强	低增强
高分化组	6	4（66.7）	2（33.3）	0	0	5（83.3）	1（16.7）	0	4（66.7）	2（33.3）	0	3（50.0）	3（50.0）
中分化组	48	48（100.0）	0	0	1（2.1）	35（72.9）	12（25.0）	0	12（25.0）	36（75.0）	0	2（4.2）	46（95.8）
低分化组	10	10（100.0）	0	0	0	3（30.0）	7（70.0）	0	0	10（100.0）	0	0	10（100.0）
P		0.007^▲			0.046^▲			0.008^▲			0.006^▲

表2 3组不同分化程度HCC的CEUS增强模式比较 [例（%）]

Tab.2 Comparison of CEUS enhanced patterns between the three groups of HCC with different differentiation degrees

组别	n	快进快退	快进慢退	快进同退	同进同退	快进同退并Kupffer 期消退
高分化组	6	1（16.7）	1（16.7）	1（16.7）	2（33.3）	1（16.7）
中分化组	48	21（43.8）	15（31.2）	2（4.2）	0	10（20.8）
低分化组	10	9（90.0）	1（10.0）	0	0	0
P		0.004^▲

图1 典型高分化HCC的超声声像图及病理图患者女，59岁，高分化HCC。a：肝右前叶高回声占位（箭头示）；b：动脉期呈均匀等增强（箭头示）；c：门脉期呈等增强（箭头示）；d：Kupffer期仍呈等增强（箭头示）；e：HCC细胞呈高分化细胞呈高分化，细胞核与细胞质之比接近正常（HE染色，×100）；f：Ki-67定位于细胞核，阳性细胞数占总计数的百分比为20%（免疫组化染色，×100）。

Fig.1 Ultrasonographic and pathological images of typical highly differentiated HCC

图2 典型中分化HCC的超声声像图及病理图患者男，51岁，中分化HCC。a：肝右前叶高回声占位（箭头示）；b：动脉期不均匀高增强（箭头示）；c：门脉期呈等增强（箭头示）；d：Kupffer期呈稍低增强（箭头示）；e：HCC细胞分化较差，细胞核与细胞质之比增高，核异质较明显（HE染色，×100）；f：Ki-67定位于细胞核，阳性细胞数占总计数的百分比为40%（免疫组化染色，×100）。

Fig.2 Ultrasonographic and pathological images of typical moderately differentiated HCC

图3 典型低分化HCC的超声声像图及病理图患者男，66岁，低分化HCC。a：肝右后叶高回声占位（箭头示）；b：动脉期不均匀高增强（箭头示）；c：门脉期呈低增强（箭头示）；d：Kupffer期呈显著低增强（箭头示）。e：HCC细胞分化最差，细胞形状不规则，排列松散（HE染色，×100）；f：Ki-67定位于细胞核，阳性细胞数占总计数的百分比为90%（免疫组化染色，×100）。

Fig.3 Ultrasonographic and pathological images of typical poorly differentiated HCC

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术前Sonazoid超声造影评估肝细胞癌病理分化程度的价值

Value of Sonazoid contrast-enhanced ultrasound for preoperatively evaluating pathological grade of hepatocellular carcinoma

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