超声造影在肝上皮样血管内皮瘤与原发性肝癌鉴别诊断中的研究
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摘要
目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)在肝上皮样血管内皮瘤(hepatic epithelioid hemangioendothelioma,HEHE)与肝细胞癌(hepatocellular carcinoma,HCC)鉴别诊断中的价值。方法:分析20例HEHE患者共31个病灶和43例HCC患者共43个病灶的CEUS图像,观察病灶的增强特点。结果:31个HEHE病灶中,16个整体增强,8个树枝样增强,7个环状增强;而43个HCC病灶中,41个整体增强,1个树枝样增强,1个环状增强(P<0.05)。在增强时相上,11个HEHE病灶快于周围正常肝实质增强,20个病灶与周围正常肝实质同步增强;而41个HCC病灶快于周围正常肝实质增强,2个病灶与周围正常肝实质同步增强(P<0.05)。在增强强度达峰值时,13个HEHE病灶呈等增强,10个病灶呈高增强,8个病灶呈低增强;而38个HCC病灶呈高增强,5个呈等增强(P<0.05);23个HEHE病灶增强均匀,8个病灶增强不均匀;而27个HCC病灶增强均匀,16个增强不均匀(P>0.05)。所有病灶在门静脉期及延迟期快速减退呈低回声改变,但HEHE减退时间快于HCC(P<0.05)。结论:CEUS在HEHE与HCC鉴别诊断中具有重要的意义。
Objective: To investigate the diagnosis value of contrast-enhanced ultrasound(CEUS) in the differentiation of hepatic epithelioid hemangioendothelioma(HEHE) and hepatocellular carcinoma(HCC). Methods: The image characteristics of CEUS were retrospectively analyzed in 31 HEHE lesions and 43 HCC lesions which were confirmed by pathology. Results: In the arterial phase, 16 HEHE lesions showed global enhancement, 8 branch enhancement and 7 rim-like enhancement, while 41 HCC lesions showed global enhancement, 1 branch enhancement and 1 rim-like enhancement(P<0.05). Synchronous enhancement was observed in 20 HEHE lesions on CEUS and rapid enhancement was observed in 11 lesions, while 41 HCC lesions presented rapid enhancement and 2 lesions presented synchronous enhancement(P<0.05). At peak time, compared to the normal liver parenchyma, hypoenhancement, iso-enhancement and hyper-enhancement were observed in 8, 13,10 HEHE lesions, and in 0, 5, 38 HCC lesions, respectively(P<0.05). Regarding the enhancement homogeneity, 23 HEHE lesions were homogeneous and 8 were heterogeneous while 27 HCC lesions were homogeneous and 16 were heterogeneous. All lesions displayed hypoecho in the portal venous and delayed phases. The decrease time in HEHE was shorter than HCC. Conclusion: CEUS is significantly important in the differential diagnosis of HEHE and HCC.
Objective: To investigate the diagnosis value of contrast-enhanced ultrasound(CEUS) in the differentiation of hepatic epithelioid hemangioendothelioma(HEHE) and hepatocellular carcinoma(HCC). Methods: The image characteristics of CEUS were retrospectively analyzed in 31 HEHE lesions and 43 HCC lesions which were confirmed by pathology. Results: In the arterial phase, 16 HEHE lesions showed global enhancement, 8 branch enhancement and 7 rim-like enhancement, while 41 HCC lesions showed global enhancement, 1 branch enhancement and 1 rim-like enhancement(P<0.05). Synchronous enhancement was observed in 20 HEHE lesions on CEUS and rapid enhancement was observed in 11 lesions, while 41 HCC lesions presented rapid enhancement and 2 lesions presented synchronous enhancement(P<0.05). At peak time, compared to the normal liver parenchyma, hypoenhancement, iso-enhancement and hyper-enhancement were observed in 8, 13,10 HEHE lesions, and in 0, 5, 38 HCC lesions, respectively(P<0.05). Regarding the enhancement homogeneity, 23 HEHE lesions were homogeneous and 8 were heterogeneous while 27 HCC lesions were homogeneous and 16 were heterogeneous. All lesions displayed hypoecho in the portal venous and delayed phases. The decrease time in HEHE was shorter than HCC. Conclusion: CEUS is significantly important in the differential diagnosis of HEHE and HCC.
引文
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[13]白敏,杜联芳,张雪梅,等.低机械指数连续实时超声造影对肝细胞肝癌的诊断价值[J].临床超声医学杂志,2008,10(8):523-526.
[14]夏宇,姜玉新,戴晴,等.肝细胞肝癌超声造影增强模式对分化程度的诊断价值[J].协和医学杂志,2014,5(1):46-49.
[15]张小龙,曹佳颖,王文平.肝上皮样血管内皮瘤超声造影表现(附2例报告)[J].肿瘤影像学,2015,24(4):317-318.
[16]SCHWEITZER N,SOUDAH B,GEBEL M,et al.Gray scale and contrast-enhanced ultrasound imaging of malignant liver tumors of vascular origin[J].United European Gastroenterol J,2015,3(1):63-71.
[2]WEISSSW,ENZINGERFM.Epithelioid hemangioendothelioma:a vascular tumor often mistaken for a carcinoma[J].Cancer,1982,50(5):970-981.
[3]MAKHLOUF H R,ISHAK K G,GOODMAN ZD.Epithel ioidhema ngioendo the lioma of the liver:a clinicopathologic study of 137 cases[J].Cancer,1999,85(3):562-582.
[4]MEHRABI A,KASHFI A,FONOUNI H,et al.Primary malignant hepatic epithelioid hemangioendothelioma:a comprehensive review of the literature with emphasis on the surgical therapy[J].Cancer,2006,107(9):2108-2121.
[5]李巧媚,周华邦,胡和平.肝脏上皮样血管内皮瘤17例临床和病理特征分析[J].中华消化杂志,2014,34(8):527-530.
[6]WALSH M M,HYTIROGLOU P,THUNG S N,et al.Epithelioid hemangioendothelioma of the liver mimicking Budd-Chiari syndrome[J].Arch Pathol Lab Med,1998,122(9):846-848.
[7]孙淑杰,迮兴宇,赵新颜.肝上皮样血管内皮瘤文献复习及临床特点分析[J].临床和实验医学杂志,2012,11(9):654-656.
[8]DIETZE O,DAVIES S E,WILLIAMS R,et al.Malignant epithelioid haemangio endothelioma of theliver:a clinicopathological and histochemical study of 12 cases[J].Histopathology,1989,15(3):225-237.
[9]刘丹,杨松青,张钧.原发性肝癌超声造影诊断价值探讨[J].中华肿瘤防治杂志,2014,21(9):698-700.
[10]贾旭春,颜临丽,储玮,等.穿刺活检诊断原发性肝上皮样血管内皮瘤7例临床病理分析[J].诊断病理学杂志,2015,22(11):669-673.
[11]钟岚,张秀辉,何度,等.肝上皮样血管内皮瘤9例临床病理分析及文献复习[J].中国普外基础与临床杂志,2015,22(2):224-229.
[12]DONG Y,WANG W P,CANTISANI V,et al.Contrastenhanced ultrasound of histologically proven hepaticepi the lioidhemangio endothelioma[J].World JGastroenterol,2016,22(19):4741-4749.
[13]白敏,杜联芳,张雪梅,等.低机械指数连续实时超声造影对肝细胞肝癌的诊断价值[J].临床超声医学杂志,2008,10(8):523-526.
[14]夏宇,姜玉新,戴晴,等.肝细胞肝癌超声造影增强模式对分化程度的诊断价值[J].协和医学杂志,2014,5(1):46-49.
[15]张小龙,曹佳颖,王文平.肝上皮样血管内皮瘤超声造影表现(附2例报告)[J].肿瘤影像学,2015,24(4):317-318.
[16]SCHWEITZER N,SOUDAH B,GEBEL M,et al.Gray scale and contrast-enhanced ultrasound imaging of malignant liver tumors of vascular origin[J].United European Gastroenterol J,2015,3(1):63-71.