【作者】 周艳平；

【导师】 廖锦堂；

【作者基本信息】 中南大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 目的:观察肝细胞癌(HCC)超声造影(CEUS)各时相特点并总结其增强模式,探讨HCC的超声造影表现与肿瘤病理分化程度的关系。方法:44例肝细胞癌患者(包括高分化18例,中分化15例,低分化11例)的44个病灶于外科手术前1周内接受了低机械指数CEUS检查。CEUS使用造影剂SonoVue和脉冲反向谐波成像(PIHI)技术。观察注射造影剂后肿瘤结节在动脉期、门脉期、延迟期的血流灌注特征,并用QLab软件绘制时间—强度曲线,分析不同分化程度HCC造影增强期各参数(始增时间、达峰时间、峰值增强时间)的差异。结果:高、中、低分化HCC组肿瘤最大径分别为(6.45±3.42cm、8.59±3.16cm、9.07±3.30cm),不同分化程度HCC组间肿瘤最大径差异无显著性(P＞0.05)。高分化组与低分化组彩色多普勒血流分级差异有统计学意义(P＜0.05),高和中、中和低分化组间血流分级差异无显著性。44例中43例(97.7%)在动脉相表现为高增强,1例为等增强:门脉相及延迟相增强信号逐渐减低,延迟相仅6例(13.6%)表现为等增强,余38例(86.4%)均为低增强。不同分化程度组在各期中造影剂消退例数差异无显著性。高、中、低分化HCC组达峰时间分别为(31.17±5.89)s、(28.53±8.06)s、(21.54±3.14)s、峰值增强时间分别为(16.44±4.12)s、(12.27±5.6)s、(7.09±1.64)s,不同分化程度HCC的达峰时间、峰值增强时间差异有显著性(P均＜0.05),而始增时间差异无显著性(P＞0.05)。结论:HCC的超声造影表现分为“快进快出”和“快进慢出”两种模式,即动脉相多为快速弥漫增强,延迟相增强信号的廓清快慢不一。不同分化程度HCC组超声造影时间—强度曲线上的达峰时间、峰值增强时间存在差异,达峰时间、峰值增强时间短的病灶分化差,超声造影可能间接提示HCC分化程度。更多还原

【Abstract】 Objective:To observe the appearance and the characterization in every vascular phase of hepatocellular carcinoma(HCC)with contrast-enhanced ultrasound(CEUS);to evaluate the relationship between the characteristic of enhanced-ultrasonography of HCC and tumor differentiation by using CEUS.Methods44 patients with a total of 44 HCC lesions(including 18 well differentiated HCCs、15 moderately differentiated HCCs、11 poorly differentiated HCCs) underwent examination of CEUS before the surgical operation in a week.CEUS was performed with SonoVue and pulse-inversion harmonic imaging(PIHI).The blood perfusion characteristics of tumors were observed after the injection of contrast ultrasound agent(SonoVue).The time-intensity curve of every nodule was draw by QLab software(PHILIPS IU22)and parameters of the time-intensity curve during contrast enhancement period(enhancement beginning time,peak intensity time,and enhancement time)were analyzed.ResultsThe size of well、moderately and poorly differentiated HCCs was(6.454±3.42)cm、(8.59±3.16)cm、(9.07±3.30)cm respectively.There was no statistical significance in the sizes with different histopathologic grading(P＞0.05). Significant difference of the blood flow grade was observed between well differentiated and poorly differentiated HCCs(P＜0.05).No significant difference in blood flow grade was observed between well-differentiated and moderately differentiated HCCs,and between moderately differentiated and poorly differentiated HCCs.In the arterial phase,43 HCCs showed fast enhancement.Then the echo level of the tumor area decreased gradually compared with that of the surrounding tissue.In the late phase,6 HCCs was visualized as isoechoic or appreciably hypoechoic lesion and 38 HCCs was visualized as obviously hypoechoic lesion.Peak intensity time in well,moderately,poorly differentiated HCC were(31.17±5.89)s、(28.53±8.06)s、(21.54±3.14)s,and enhancement time(16.44±4.12)s、(12.27±5.6)s、(7.09±1.64)s respectively,significant differences were shown between peak intensity time、enhancement time and tumor differentiation(P＜0.05).But there was no statistical significance in enhancement beginning time with different histopathologic grading.ConclusionsThe enhancement pattern of HCC was differentiated as "fast-in and fast-out" and "fast-in and slow-out",In the arterial phase,HCC has a typical enhancement consisting in a diffuse and rapid enhancement。Most HCCs were described as obviously hypoechoic and the others were isoechoic or appreciably hypoechoic in the late phase。There is relationship between the peak intensity time、enhancement time of HCCs and tumor differentiation.Those lesions which were enhanced quickly may be poor differentiated.CEUS maybe prompting the differentiation of tumors.更多还原