超声造影诊断原发性肝癌临床价值及与病理分化相关性研究
发布时间：2018-09-13 09:56
【摘要】：目的 本研究主要目的是探讨超声造影诊断原发性肝癌特征性表现及与病理分化相关性研究，旨在确立超声造影技术定性诊断肝癌的重要临床价值。 资料与方法 对我院2010年1月至2013年12月472例肝占位性病变（病灶直径0.6-8.4cm，患者多个病灶时取直径最大病灶），其中男308例，女164例，年龄23-78岁，平均50.7±15.3岁,进行超声造影检查，并与病理相对照。 超声诊断仪器是Siemens Sequoia512，探头4C-1，频率1-4MHz，利用超声造影对比脉冲序列（contrast pulse sequencing，CPS）成像技术；PhilipsiU22超声仪，探头频率1-5MHz，具备低机械指数（0.04-0.10）脉冲反向谐波成像技术。超声造影剂为意大利Bracco公司生产的SonoVue造影剂。超声造影全过程实时全程录像的动态存储技术，造影后逐帧分析研究病灶内造影剂开始增强时间、达峰时间、开始廓清时间，病灶增强与廓清方式、形态等，同时将超声造影灌注特征及增强模式与其病理结果对比分析，造影诊断至少由2名资深超声诊断医师独立进行分析判断。完整的超声造影增强过程分为3个时相[1]：动脉期（10s~30s）、门脉期（31s~120s）、延迟期（121s~360s）。 结果 1．472例肝占位性病变中经病理证实的恶性肿瘤267例，良性肿瘤205例。 1.1.原发性肝癌超声造影的特征性表现：病灶动脉期呈快速整体不均质增强，门脉期快速廓清，其起始增强时间、开始廓清时间并总持续时间均短于良性肿瘤（P＜0.01）。其中肝细胞性肝癌多表现为“快进快出”，即动脉期球状整体快速增强、门脉期快速廓清；胆管细胞性肝癌多表现为“快进更快出”，动脉期树枝状快速增强，廓清时间更快于肝细胞性肝癌。 1.2.肝良性肿瘤特征性表现多为“慢进慢出”、“快进慢出”“无增强”等，肝血管瘤向心性增强，局灶性结节增生放射状或泉涌状增强，但门脉晚期、延迟期廓清均慢于周边肝组织；炎性假瘤以无增强为主要特征，肝硬化结节与周边肝组织同步显影。 2.超声造影发现并确定原发性肝癌4种血供分型 2.1．肝动脉单独血供或以肝动脉血供为主型，占79.8%（213/267）其表象为病灶均在动脉期开始增强，呈球形状快速填充，门脉期肝实质开始增强，病灶开始快速廓清，呈等或低回声，延迟期病灶回声低于周边肝组织。 2.2．肝动脉和门静脉双重血供型，占13.5%（36/267）其表象为动脉期病灶开始增强，门脉期肝实质开始增强，而病灶持续增强，延迟期病灶开始缓慢廓清。 2.3．肝动脉和门静脉双重血供且同时存在动静脉瘘型，占5.2%（14/267）其表象为动脉期病灶即开始增强，门脉期病灶持续增强，，延迟期由于动静脉瘘的存在，病灶始终与周围肝组织同步显影。 2.4.门静脉单独血供或以门静脉血供为主型，占1.5%（4/267）其表象为动脉期病灶内造影剂增强不明显，门脉期病灶内造影剂开始缓慢增强，延迟期早期边肝组织同步显影，延迟期晚期病灶内造影剂低于周边肝组织。 3.超声造影诊断原发性肝癌的敏感性、特异性、准确性与病理诊断相对照，其结果分别为：98.9%(264/267)、95.6%(196/205)、97.4%（460/472），约登指数、阳性似然比、阴性似然比分别为：0.94、22.5和0.012。 4.原发性肝癌超声造影廓清时间差异表现与病理分化程度相关性对照具有统计学意义（P＜0.05）。 结论 超声造影技术能显著提高肝脏良恶性肿瘤诊断与鉴别诊断的准确性，并能确定肝癌血供分型，为临床肝癌早期正确的诊断和治疗方案的选择、有效规范治疗具有重要价值，同时为肿瘤分化程度的界定提供了影像学参考依据。
[Abstract]:objective
The purpose of this study was to investigate the characteristic features of contrast-enhanced ultrasonography (CEUS) in the diagnosis of primary hepatocellular carcinoma (PHC) and its correlation with pathological differentiation.
Data and methods
From January 2010 to December 2013, 472 cases of hepatic space-occupying lesions (lesions with a diameter of 0.6-8.4 cm and the largest diameter of lesions) were examined by contrast-enhanced ultrasonography (CEUS), including 308 males and 164 females, aged 23-78, with an average age of 50.7 (+ 15.3).
Ultrasound diagnostic instrument is Siemens Sequoia 512, probe 4C-1, frequency 1-4MHz, using contrast pulse sequencing (CPS) imaging technology; Philipsi U22 ultrasonic instrument, probe frequency 1-5MHz, with low mechanical index (0.04-0.10) pulse reverse harmonic imaging technology. NoVue Contrast Agent. Dynamic storage technology of real-time full-range video recording during the whole process of contrast-enhanced ultrasound. After contrast-enhanced, frame-by-frame analysis of contrast media in the lesion start enhancement time, peak time, start clearance time, lesion enhancement and clearance mode, morphology, etc. At the same time, contrast-enhanced ultrasound perfusion characteristics and enhancement mode were compared with their pathological results, contrast-enhanced diagnosis. The complete contrast-enhanced ultrasound was divided into three phases: arterial phase (10s-30s), portal phase (31s-120s) and delayed phase (121s-360s).
Result
In 1.472 cases of hepatic space occupying lesions, 267 cases were confirmed by pathology, 205 cases were benign tumors.
1.1 Contrast-enhanced ultrasonography of primary hepatocellular carcinoma (PHC) showed rapid global heterogeneous enhancement in the arterial phase, rapid clearance in the portal phase, shorter initial enhancement time, initial clearance time and total duration than benign tumors (P < 0.01). Strong, portal phase of rapid clearance; bile duct cell hepatocellular carcinoma mostly manifested as "fast in and out", arterial phase dendritic rapid enhancement, clearance time faster than hepatocellular carcinoma.
1.2. Most of the benign hepatic tumors were characterized by "slow in and slow out", "fast in and slow out", "no enhancement" and so on. The hepatic hemangioma was centripetal enhancement, focal nodular hyperplasia was radial or spring-like enhancement, but the clearance of late portal vein and delayed phase was slower than that of peripheral liver tissue. Synchronous tissue development.
2. contrast-enhanced ultrasound found and identified 4 types of blood supply for primary liver cancer.
2.1. Hepatic artery alone or hepatic artery blood supply as the main type, accounted for 79.8% (213/267) of the lesions were enhanced in the arterial phase, the rapid filling in a spherical shape, portal phase hepatic parenchyma began to strengthen, lesions began to clear quickly, showed isoechoic or hypoechoic, delayed lesions echo lower than the surrounding liver tissue.
2.2 The hepatic artery and portal vein double blood supply type, accounting for 13.5% (36/267) of the lesions in the arterial phase began to enhance, the hepatic parenchyma in the portal phase began to strengthen, and the lesions continued to strengthen, the delayed lesions began to clear slowly.
2.3. The hepatic artery and portal vein had double blood supply and arteriovenous fistula, accounting for 5.2% (14/267). The lesions in the arterial phase began to strengthen, and the lesions in the portal phase continued to strengthen. The lesions in the delayed phase were always developed synchronously with the surrounding liver tissue due to the presence of arteriovenous fistula.
2.4. Portal vein blood supply alone or portal vein blood supply as the main type, accounting for 1.5% (4/267) of the appearance of intra-arterial contrast media enhancement was not obvious, intra-portal contrast media began to slowly enhance, early delayed peripheral liver tissue synchronous imaging, late delayed lesions contrast media lower than peripheral liver tissue.
3. The sensitivity, specificity and accuracy of contrast-enhanced ultrasound in the diagnosis of primary hepatocellular carcinoma were 98.9% (264/267), 95.6% (196/205), 97.4% (460/472), Jordan index, positive likelihood ratio, negative likelihood ratio were 0.94, 22.5 and 0.012, respectively.
4. The correlation between the clearance time of contrast-enhanced ultrasound and the degree of pathological differentiation was statistically significant (P<0.05).
conclusion
Contrast-enhanced ultrasonography can significantly improve the accuracy of diagnosis and differential diagnosis of benign and malignant liver tumors, and determine the blood supply classification of hepatocellular carcinoma. It is of great value for the correct early diagnosis and treatment of hepatocellular carcinoma, and for the effective standardization of treatment.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R735.7
本文编号：2240846
[Abstract]:objective
The purpose of this study was to investigate the characteristic features of contrast-enhanced ultrasonography (CEUS) in the diagnosis of primary hepatocellular carcinoma (PHC) and its correlation with pathological differentiation.
Data and methods
From January 2010 to December 2013, 472 cases of hepatic space-occupying lesions (lesions with a diameter of 0.6-8.4 cm and the largest diameter of lesions) were examined by contrast-enhanced ultrasonography (CEUS), including 308 males and 164 females, aged 23-78, with an average age of 50.7 (+ 15.3).
Ultrasound diagnostic instrument is Siemens Sequoia 512, probe 4C-1, frequency 1-4MHz, using contrast pulse sequencing (CPS) imaging technology; Philipsi U22 ultrasonic instrument, probe frequency 1-5MHz, with low mechanical index (0.04-0.10) pulse reverse harmonic imaging technology. NoVue Contrast Agent. Dynamic storage technology of real-time full-range video recording during the whole process of contrast-enhanced ultrasound. After contrast-enhanced, frame-by-frame analysis of contrast media in the lesion start enhancement time, peak time, start clearance time, lesion enhancement and clearance mode, morphology, etc. At the same time, contrast-enhanced ultrasound perfusion characteristics and enhancement mode were compared with their pathological results, contrast-enhanced diagnosis. The complete contrast-enhanced ultrasound was divided into three phases: arterial phase (10s-30s), portal phase (31s-120s) and delayed phase (121s-360s).
Result
In 1.472 cases of hepatic space occupying lesions, 267 cases were confirmed by pathology, 205 cases were benign tumors.
1.1 Contrast-enhanced ultrasonography of primary hepatocellular carcinoma (PHC) showed rapid global heterogeneous enhancement in the arterial phase, rapid clearance in the portal phase, shorter initial enhancement time, initial clearance time and total duration than benign tumors (P < 0.01). Strong, portal phase of rapid clearance; bile duct cell hepatocellular carcinoma mostly manifested as "fast in and out", arterial phase dendritic rapid enhancement, clearance time faster than hepatocellular carcinoma.
1.2. Most of the benign hepatic tumors were characterized by "slow in and slow out", "fast in and slow out", "no enhancement" and so on. The hepatic hemangioma was centripetal enhancement, focal nodular hyperplasia was radial or spring-like enhancement, but the clearance of late portal vein and delayed phase was slower than that of peripheral liver tissue. Synchronous tissue development.
2. contrast-enhanced ultrasound found and identified 4 types of blood supply for primary liver cancer.
2.1. Hepatic artery alone or hepatic artery blood supply as the main type, accounted for 79.8% (213/267) of the lesions were enhanced in the arterial phase, the rapid filling in a spherical shape, portal phase hepatic parenchyma began to strengthen, lesions began to clear quickly, showed isoechoic or hypoechoic, delayed lesions echo lower than the surrounding liver tissue.
2.2 The hepatic artery and portal vein double blood supply type, accounting for 13.5% (36/267) of the lesions in the arterial phase began to enhance, the hepatic parenchyma in the portal phase began to strengthen, and the lesions continued to strengthen, the delayed lesions began to clear slowly.
2.3. The hepatic artery and portal vein had double blood supply and arteriovenous fistula, accounting for 5.2% (14/267). The lesions in the arterial phase began to strengthen, and the lesions in the portal phase continued to strengthen. The lesions in the delayed phase were always developed synchronously with the surrounding liver tissue due to the presence of arteriovenous fistula.
2.4. Portal vein blood supply alone or portal vein blood supply as the main type, accounting for 1.5% (4/267) of the appearance of intra-arterial contrast media enhancement was not obvious, intra-portal contrast media began to slowly enhance, early delayed peripheral liver tissue synchronous imaging, late delayed lesions contrast media lower than peripheral liver tissue.
3. The sensitivity, specificity and accuracy of contrast-enhanced ultrasound in the diagnosis of primary hepatocellular carcinoma were 98.9% (264/267), 95.6% (196/205), 97.4% (460/472), Jordan index, positive likelihood ratio, negative likelihood ratio were 0.94, 22.5 and 0.012, respectively.
4. The correlation between the clearance time of contrast-enhanced ultrasound and the degree of pathological differentiation was statistically significant (P<0.05).
conclusion
Contrast-enhanced ultrasonography can significantly improve the accuracy of diagnosis and differential diagnosis of benign and malignant liver tumors, and determine the blood supply classification of hepatocellular carcinoma. It is of great value for the correct early diagnosis and treatment of hepatocellular carcinoma, and for the effective standardization of treatment.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R735.7
【参考文献】
相关期刊论文 前10条
1 司芩;黄声稀;仝威;钱晓莉;吕校平;黄艳丽;;肝癌及门静脉癌栓血供灌注特征的彩超与超声造影研究[J];东南国防医药;2011年01期
2 张拾命;黄道中;;超声造影对良恶性肝脏局灶性病变的鉴别诊断价值[J];放射学实践;2011年05期
3 王晓东;梁群兴;赵萍;;超声造影和彩色多普勒超声在原发性肝细胞肝癌诊断中的应用[J];广东医学;2013年12期
4 K.Numata;M.Morimoto;M.Kondo;S.Takebayashi;M.Okada;尚全良;;肝脏局灶肿瘤:3D perflubutane微泡对比剂增强超声与3D增强多层CT特征[J];国际医学放射学杂志;2009年03期
5 蒋映丰;周启昌;朱才义;;超声造影在肝脏良恶性肿瘤鉴别诊断中的价值[J];中南大学学报(医学版);2012年01期
6 杨龙;王绮;吴刚;袁建军;郝远瑞;田建国;;原发性肝癌超声造影灌注改变与生物学特性关系研究[J];中华实用诊断与治疗杂志;2010年05期
7 王凹弟;;原发性肝癌超声造影特征与病理对照研究[J];中华保健医学杂志;2011年01期
8 袁建华,陈方宏,俞文强,刘子江;间接门静脉数字减影造影对肝癌血供的研究[J];介入放射学杂志;1999年02期
9 李春雨;黄丽萍;张宏宇;李红丹;尹帅;;不同组织病理学类型肝细胞癌超声造影定量血流灌注参数的差异[J];中国介入影像与治疗学;2012年06期
10 廖继安;王爱玉;张化诚;金夏祥;;小肝癌超声造影特征与病理组织学分析研究[J];临床超声医学杂志;2012年02期
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