肝细胞癌超声造影动态增强模式影响因素的研究

发布时间：2018-07-10 06:08

本文选题：肝细胞癌 + 细胞分化程度　；参考：《第三军医大学》2017年硕士论文

【摘要】：研究背景肝细胞癌(Hepatocellular carcinoma,HCC)是起源于肝细胞的恶性肿瘤,占原发性肝脏恶性肿瘤的80%-90%。在世界范围内,HCC的发病率男性居第五位,女性居第九位,死亡率男性居第二位,女性居第六位。超声造影(Contrast-enhanced ultrasound,CEUS)在肝脏病变的诊断中应用广泛,诊断HCC的敏感性和特异性与增强CT(Computed Tomography,计算机断层摄影技术)和增强MRI(Magnetic Resonance Imaging,磁共振成像)相当。不同患者HCC超声造影增强模式间有差异,但影响增强模式的因素尚不清楚。有研究报导高分化HCC与中-低分化HCC间超声造影增强模式有差别,但中分化HCC与低分化HCC间是否有差异尚不清楚。此外,病灶大小及肝脏背景是否会对HCC超声造影增强模式产生影响尚不清楚。目的(1)进一步分析细胞分化程度对HCC超声造影增强模式的影响,尤其是中分化HCC和低分化HCC间的差异;(2)分析病灶大小对HCC超声造影增强模式的影响;(3)分析肝脏背景对HCC超声造影增强模式的影响。材料和方法回顾性分析了2005年1月到2015年12月在第三军医大学西南医院行超声检查最大径5cm的单发病灶并经手术切除或穿刺活检病理证实为HCC的患者,所有病人术前1月内行超声造影检查。肉眼观察病灶超声造影的动态增强过程,记录病灶动脉相增强模式、廓清模式、开始增强时间、达峰时间及开始廓清时间。计量资料的组间比较用单因素方差分析或t检验,计数资料的组间比较用卡方检验或确切概率法,以P0.05为差异有统计学意义。结果1、共纳入276例HCC患者,平均年龄51.1±11.4岁(范围:23-84岁),其中男性患者240例(86.9%)。230(83.3%)例患者经病理和/或实验室检查证实有肝硬化和/或慢性乙型肝炎。所有病灶的平均直径为3.2±1.0cm(范围:1.0-4.9cm)。2、270个(97.8%)HCC病灶动脉相为高增强,其中203个(75.2%)为整体高增强及67个(24.8%)个为不均匀高增强。高分化HCC(84.4%)及中分化HCC(77.0%)动脉相为整体高增强的比例高于低分化HCC(56.3%),差异有统计学意义(P0.05)。直径3cm的HCC病灶动脉相为不均匀高增强(35.2%)的比例高于直径≤3cm的HCC病灶(10.0%),差异有统计学意义(P0.05)。肝脏背景不影响HCC动脉相的增强模式。3、270个动脉相高增强的病灶纳入廓清模式的研究。高分化HCC延迟相廓清及不廓清的比例分别为41.9%及21.5%,明显高于中分化HCC(27.6%;10.2%)或低分化HCC(20.3%;3.8%),差异有统计学意义(P0.05)。中分化HCC与低分化HCC廓清模式的比例差异无统计学意义(P0.05)。不同病灶大小及肝脏背景的HCC间各廓清模式的比例差异无统计学意义(P0.05)。4、不同分化程度、病灶大小、肝脏背景的HCC间开始增强时间及达峰时间差异无统计学意义(P0.05)。低分化HCC廓清最快(83.0±39.8s),中分化HCC其次(100.4±52.1s),高分化HCC廓清最慢(132.3±54.2s),两两比较差异有统计学意义(P0.05)。直径3cm的HCC病灶(97.2±51.3s)较直径≤3cm HCC病灶(113.9±53.5s)廓清更快,差异有统计学意义(P0.05)。肝硬化背景HCC(106.5±52.2s)和非肝硬化背景HCC(101.6±54.0s)间开始廓清时间差异无统计学意义(P0.05)。结论1、分化程度对HCC超声造影动态增强特征有影响,高分化HCC动脉相多为整体增强,且大部分病灶为延迟相廓清或不廓清。中分化HCC与低分化HCC间各廓清模式的比例无明显差别,但低分化HCC开始廓清时间较中分化HCC更早。2、病灶大小影响HCC超声造影动态增强特征,直径3cm HCC病灶动脉相多为不均匀高增强,且廓清更快。3、肝脏背景不影响HCC超声造影动态增强特征。
[Abstract]:Background Hepatocellular carcinoma (HCC) is a malignant tumor originating from hepatocytes. The incidence of 80%-90%. in primary liver malignancies is in the world. The incidence of HCC is the fifth in male and ninth in women. The mortality rate is second, and the female is sixth. Contrast (Contrast-enhanced ultrasound, CEUS). It is widely used in the diagnosis of liver lesions. The sensitivity and specificity of the diagnosis of HCC are equivalent to enhanced CT (Computed Tomography, computed tomography) and enhanced MRI (Magnetic Resonance Imaging, magnetic resonance imaging). There are differences between the enhanced modes of contrast enhanced ultrasound contrast in different patients, but the factors affecting the enhanced mode are not yet clear. It is reported that there is a difference between high differentiated HCC and medium to low differentiated HCC contrast enhancement mode, but it is not clear whether the difference between HCC and low differentiated HCC is not clear. In addition, it is not clear whether the size of the lesion and the liver background will affect the contrast enhancement mode of HCC. Objective (1) further analysis of the degree of cell differentiation to HCC contrast enhancement The influence of strong pattern, especially the difference between medium differentiated HCC and low differentiated HCC; (2) analysis of the effect of lesion size on enhanced pattern of HCC ultrasound contrast; (3) analysis of the effect of liver background on the enhancement pattern of HCC ultrasound contrast. The materials and methods reviewed the ultrasound examination in Southwest Hospital of Third Military Medical University from January 2005 to December 2015. The single lesion of the maximum diameter 5cm was confirmed by surgical resection or biopsy. All patients were examined by contrast ultrasound before operation in January. The dynamic enhancement process of ultrasound contrast was observed by the naked eye. The enhancement pattern of the artery phase, the clearance mode, the time of enhancement, the time of peak time and the time of clearance were recorded. A single factor ANOVA or t test was used to compare the group comparison with the chi square test or the exact probability method. The difference was statistically significant with P0.05. Results 1, 276 cases of HCC were included, the average age was 51.1 + 11.4 years (range: 23-84 years), of which 240 (86.9%).230 (83.3%) patients were in the pathology and / or laboratory. Liver cirrhosis and / or chronic hepatitis B were confirmed. The average diameter of all lesions was 3.2 + 1.0cm (range: 1.0-4.9cm).2270 (97.8%) HCC focus artery phase was high, of which 203 (75.2%) were high overall and 67 (24.8%) were inhomogeneous high enhancement. High differentiation HCC (84.4%) and middle differentiation HCC (77%) arterial phase increased as a whole The strong ratio was higher than that of low differentiated HCC (56.3%). The difference was statistically significant (P0.05). The proportion of arterial phase in HCC lesion in diameter 3cm was higher than that of HCC lesion with diameter less than 3cm (10%). The difference was statistically significant (P0.05). The liver background did not affect the enhancement pattern of the arterial phase of HCC. The clearance and dissection of the highly differentiated HCC delayed phase were 41.9% and 21.5%, respectively, which were significantly higher than that of middle differentiated HCC (27.6%; 10.2%) or low differentiated HCC (20.3%; 3.8%). The difference was statistically significant (P0.05). There was no significant difference (P0.05) between the differentiated HCC and the low differentiated HCC clearance model (P0.05). There was no statistical significance (P0.05).4, the difference degree of differentiation, the degree of differentiation, the size of the lesion, the beginning of the enhancement time and the peak time difference between the HCC of the liver background were not statistically significant (P0.05). The low differentiated HCC clearance was the fastest (83 + 39.8s), the intermediate HCC was next (100.4 + 52.1s), and the high differentiated HCC clearance was the slowest (132.3 + 54.2s) (132.3 + 54.2s) The difference was statistically significant (P0.05). The HCC lesion in diameter 3cm (97.2 + 51.3s) was faster than the diameter less than 3cm HCC lesion (113.9 + 53.5s), and the difference was statistically significant (P0.05). There was no significant difference in the time difference between the liver cirrhosis background HCC (106.5 + 52.2s) and the non cirrhosis background HCC (101.6 + 54.0s). Conclusion 1 The degree of transformation was influenced by the dynamic enhanced features of HCC ultrasound contrast. Most of the highly differentiated HCC arterial phase was enhanced, and most of the lesions were delayed or dissection. The proportion of the differentiated HCC and the low differentiated HCC was not significantly different, but the low differentiated HCC began to clear up the.2 earlier than the medium HCC, and the size of the lesion affected HCC ultrasound. The dynamic contrast enhancement features of 3cm HCC in diameter are mostly uneven and high enhancement, and the clearance of.3 is faster. The liver background does not affect the dynamic enhancement characteristics of HCC ultrasound contrast.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R445.1

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