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中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (04) : 353 -357. doi: 10.3877/cma.j.issn.2095-3232.2019.04.017

所属专题： 文献；

临床研究

超声造影定量灌注分析在术前评估肝细胞癌组织分化程度中的应用
林满霞1, 张晓儿1, 陈泽斌2, 谢晓燕1, 匡铭3,†()   
  1. 1. 510080　广州，中山大学附属第一医院超声医学科　中山大学超声诊断与介入超声研究所
    2. 510080　广州，中山大学附属第一医院肝脏外科
    3. 510080　广州，中山大学附属第一医院超声医学科　中山大学超声诊断与介入超声研究所；510080　广州，中山大学附属第一医院肝脏外科
  • 收稿日期:2019-05-18 出版日期:2019-08-10
  • 通信作者: 匡铭
  • 基金资助:
    广东省科技发展专项资金(2017A020215011)

Application of quantitative contrast-enhanced ultrasound perfusion analysis in preoperative evaluation of differentiation of hepatocellular carcinoma

Manxia Lin1, Xiaoer Zhang1, Zebin Chen2, Xiaoyan Xie1, Ming Kuang3,†()   

  1. 1. Department of Ultrasound Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    3. Department of Ultrasound Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2019-05-18 Published:2019-08-10
  • Corresponding author: Ming Kuang
  • About author:
    Corresponding author: Kuang Ming, Email:
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引用本文：

林满霞, 张晓儿, 陈泽斌, 谢晓燕, 匡铭. 超声造影定量灌注分析在术前评估肝细胞癌组织分化程度中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2019, 08(04): 353-357.

Manxia Lin, Xiaoer Zhang, Zebin Chen, Xiaoyan Xie, Ming Kuang. Application of quantitative contrast-enhanced ultrasound perfusion analysis in preoperative evaluation of differentiation of hepatocellular carcinoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(04): 353-357.

目的

探讨超声造影定量灌注（Q-CEUS）分析评估术前肝细胞癌（肝癌）组织分化程度的可行性和应用价值。

方法

回顾性分析2015年1月至2016年6月在中山大学附属第一医院接受超声造影检查的91例肝癌患者临床资料。其中男78例，女13例；平均年龄（52±12）岁。患者均签署知情同意书，符合医学伦理学规定。对患者进行Q-CEUS灌注分析，检测峰值强度上升时间（RT）、达峰时间（TTP）等参数。RT、TTP与肝癌组织分化程度关系分析采用单因素方差分析，采用受试者工作特征（ROC）曲线评价灌注参数对肝癌组织分化程度的诊断价值。

结果

高、中、低分化肝癌患者分别为22、53和16例。Q-CEUS分析显示肿瘤和瘤内最高增强区（TER）的RT、TTP与分化程度相关，随分化程度降低而变小（F=21.374，10.575和14.629，17.432；P<0.05）。肿瘤和TER的RT、TTP在高、中分化组间差异有统计学意义（HSD-t=13.317，13.136和15.003，14.473；P<0.05），高、低分化组间差异亦有统计学意义（HSD-t=11.425，10.754和12.741，12.145；P<0.05）。肿瘤RT、TTP诊断高分化肝癌的ROC曲线下面积分别为0.835、0.696，TER的RT、TTP诊断高分化肝癌的ROC曲线下面积为0.805、0.783，且肿瘤RT的ROC曲线下面积明显大于肿瘤TTP（Z =2.855，P<0.05）。

结论

Q-CEUS灌注参数RT、RT可用于高分化肝癌的鉴别诊断，诊断价值中等，且RT的诊断价值优于TTP。

关键词: 癌，肝细胞, 超声检查，介入性, 术前评估
Objective

To explore the feasibility and application value of quantitative contrast-enhanced ultrasound perfusion (Q-CEUS) in the preoperative evaluation of differentiation degree of hepatocellular carcinoma (HCC).

Methods

Clinical data of 91 patients with HCC undergoing contrast-enhanced ultrasound in the First Affiliated Hospital of Sun Yat-sen University from January 2015 to June 2016 were retrospectively analyzed. Among them, 78 patients were male and 13 were female, with an average age of (52±12) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Q-CEUS analysis was performed in all patients. Related data such as the rise time (RT) of peak intensity and time to peak (TTP) were recorded. The relationship among RT, TTP and the differentiation of HCC was analyzed by one-way ANOVA. The diagnostic value of perfusion parameters on the HCC differentiation was evaluated by receiver operating characteristic (ROC) curve.

Results

In total,22, 53 and 16 patients were respectively diagnosed with highly-, moderately- and lowly-differentiated HCC. Q-CEUS analysis indicated that RT and TTP in the tumor and tip-enhanced region (TER) were significantly correlated with the HCC differentiation, they decreased along with the decrease of differentiation degree (F=21.374, 10.575 and 14.629, 17.432; P<0.05). The RT and TTP in the tumor and TER significantly differed between the highly- and moderately-differentiated groups (HSD-t=13.317, 13.136 and 15.003, 14.473; P<0.05), and between the highly- and lowly-differentiated groups (HSD-t=11.425, 10.754 and 12.741, 12.145; P<0.05). The area under the ROC curve of RT and TTP in the tumor was respectively 0.835 and 0.696 for diagnosing highly-differentiated HCC, and was respectively 0.805 and 0.783 in TER. The area under the ROC curve of RT in the tumor was significantly larger than that of TTP (Z=2.855, P<0.05).

Conclusions

Q-CEUS parameters, such as RT and TTP, can be used in the differential diagnosis of highly-differentiated HCC with moderate diagnostic value. The diagnostic value of RT is better than that of TTP.

Key words: Carcinoma, hepatocellular, Ultrasonography, interventional, Preoperative evaluation
表1 不同组织分化程度肝细胞癌患者临床特征分布
分化程度 例数 性别（例，男/女） 年龄（岁，±s） 肝炎背景（例） 肿瘤直径（cm，±s）
无 乙肝 丙肝
高分化 22 20/2 58±12 2 19 1 2.7±1.1
中分化 53 45/8 50±12 1 51 1 3.6±1.0
低分化 16 13/3 49±12 0 16 0 4.1±0.8
表2 不同组织分化程度肝细胞癌组间肿瘤、瘤内最高增强区灌注参数比较
分化程度 肿瘤 瘤内最高增强区
Imax（%，±s） RT（s，±s） TTP（s，±s） mTT [s，M(QR)] Imax（%，±s） RT（s，±s） TTP（s，±s） mTT[s，M(QR)]
高分化 483±241 17.3±3.6 18.7±6.1 83（13～314） 807±463 16.8±4.0 19.5±5.9 71（12～270）
中分化 232±30 13.3±2.9 15.0±3.5 51（19～302） 299±34 13.1±3.7 14.5±3.6 42（15～302）
低分化 215±46 11.4±1.4 12.7±2.1 50（18～251） 300±58 10.8±1.9 12.1±2.5 42（20～251）
统计值 F=1.612 F=21.374 F=10.575 Z=3.611 F=1.838 F=14.629 F=17.432 Z=3.184
P值 0.205 0.000 0.000 0.164 0.165 0.000 0.000 0.204
表3 RT、TTP对高分化肝癌诊断价值分析
项目 曲线下面积 诊断界值 敏感度 特异度 阳性预测值 阴性预测值
肿瘤 ? ? ? ? ? ?
? RT 0.835 14.6 0.82（0.60～0.95） 0.86（0.75～0.93） 0.64（0.44～0.81） 0.94（0.85～0.98）
? TTP 0.696 18.0 0.50（0.28～0.72） 0.93（0.84～0.98） 0.69（0.41～0.89） 0.85（0.75～0.92）
瘤内最高增强区 ? ? ? ? ? ?
? RT 0.805 11.8 1.00（0.85～1.00） 0.51（0.38～0.63） 0.39（0.27～0.54） 1.00（0.90～1.00）
? TTP 0.783 17.6 0.59（0.36～0.79） 0.88（0.78～0.95） 0.62（0.39～0.82） 0.87（0.77～0.94）
图1 超声造影灌注参数对高分化肝细胞癌诊断的ROC曲线图
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