中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2015年
6期
478-483
,共6页
林庆光%邹如海%王建伟%韩峰%裴小青%李安华
林慶光%鄒如海%王建偉%韓峰%裴小青%李安華
림경광%추여해%왕건위%한봉%배소청%리안화
癌,肝细胞%微血管%超声检查%造影剂
癌,肝細胞%微血管%超聲檢查%造影劑
암,간세포%미혈관%초성검사%조영제
Carcinoma,Hepatocellular%Microvascular%Ultrasonograhy%Contrast media
目的：分析超声造影（CEUS）定量参数与肝细胞癌（HCC）微血管形态的关系，探讨应用CEUS术前对HCC微血管形态进行分型的可行性。方法回顾性分析2010年4月至2011年12月于中山大学肿瘤防治中心接受CEUS检查并行手术切除及病理证实的94例HCC患者，并脱机采用SonoTumor软件行时间-强度曲线分析，软件自动获得峰值强度（PE）、上升时间（RT）、灌注速率（WiR）、灌注指数（WiPI）、曲线下面积（WiAUC）和平均渡越时间（MTT）。术后病理标本行CD34免疫组化染色，对其进行微血管形态分型。采用Fisher确切概率法和χ2检验比较不同微血管形态分型HCC患者临床参数差异；采用单因素方差分析比较不同微血管形态分型HCC的PE、RT、WiR、WiPI、WiAUC、MTT差异，进一步组间两两比较采用LSD-t检验。结果 CD34免疫组化染色结果显示，94例HCC可分为毛细血管型28例、血窦型14例、混合型52例。不同微血管形态分型HCC患者的临床参数差异均无统计学意义。毛细血管型HCC的PE、RT、WiR、WiPI、WiAUC和MTT分别为（4350.7±2566.0）a.u、（10.7±3.2）s、（717.0±489.9）a.u、（12820.3±8331.6）a.u、（128240.8±74487.1） a.u、（71.9±33.1）s，血窦型HCC分别为（2471.6±1107.1）a.u、（16.2±4.2）s、（321.9±171.8）a.u、（5561.4±2938.0）a.u、（86780.1±47563.7） a.u、（117.8±69.6）s，混合型HCC分别为（3563.2±2343.1）a.u、（14.1±4.8）s、（519.4±403.2）a.u、（9015.3±6884.7）a.u、（110208.4±77511.3）a.u、（107.5±88.2）s。其中PE、WiR及WiPI呈毛细血管型-混合型-血窦型逐渐降低的趋势，RT呈毛细血管型-混合型-血窦型逐渐增加的趋势。毛细血管型HCC与血窦型、混合型HCC的WiR、WiPI、RT差异均有统计学意义（WiR：t值分别为3.87、3.3；WiPI：t值分别为2.96、2.06；RT：t值分别为3.19、2.34；均P＜0.05）；毛细血管型HCC与血窦型HCC的PE差异有统计学意义（t=2.51，P＜0.05）；毛细血管型HCC与混合型HCC的PE差异无统计学意义；混合型HCC与血窦型HCC的PE、WiR、WiPI、RT差异均无统计学意义。不同微血管形态分型HCC的WiAUC及MTT差异均无统计学意义。结论不同微血管形态分型HCC的CEUS定量参数差异显著，可利用非入侵性的CEUS技术对HCC的微血管形态进行初步判断。
目的：分析超聲造影（CEUS）定量參數與肝細胞癌（HCC）微血管形態的關繫，探討應用CEUS術前對HCC微血管形態進行分型的可行性。方法迴顧性分析2010年4月至2011年12月于中山大學腫瘤防治中心接受CEUS檢查併行手術切除及病理證實的94例HCC患者，併脫機採用SonoTumor軟件行時間-彊度麯線分析，軟件自動穫得峰值彊度（PE）、上升時間（RT）、灌註速率（WiR）、灌註指數（WiPI）、麯線下麵積（WiAUC）和平均渡越時間（MTT）。術後病理標本行CD34免疫組化染色，對其進行微血管形態分型。採用Fisher確切概率法和χ2檢驗比較不同微血管形態分型HCC患者臨床參數差異；採用單因素方差分析比較不同微血管形態分型HCC的PE、RT、WiR、WiPI、WiAUC、MTT差異，進一步組間兩兩比較採用LSD-t檢驗。結果 CD34免疫組化染色結果顯示，94例HCC可分為毛細血管型28例、血竇型14例、混閤型52例。不同微血管形態分型HCC患者的臨床參數差異均無統計學意義。毛細血管型HCC的PE、RT、WiR、WiPI、WiAUC和MTT分彆為（4350.7±2566.0）a.u、（10.7±3.2）s、（717.0±489.9）a.u、（12820.3±8331.6）a.u、（128240.8±74487.1） a.u、（71.9±33.1）s，血竇型HCC分彆為（2471.6±1107.1）a.u、（16.2±4.2）s、（321.9±171.8）a.u、（5561.4±2938.0）a.u、（86780.1±47563.7） a.u、（117.8±69.6）s，混閤型HCC分彆為（3563.2±2343.1）a.u、（14.1±4.8）s、（519.4±403.2）a.u、（9015.3±6884.7）a.u、（110208.4±77511.3）a.u、（107.5±88.2）s。其中PE、WiR及WiPI呈毛細血管型-混閤型-血竇型逐漸降低的趨勢，RT呈毛細血管型-混閤型-血竇型逐漸增加的趨勢。毛細血管型HCC與血竇型、混閤型HCC的WiR、WiPI、RT差異均有統計學意義（WiR：t值分彆為3.87、3.3；WiPI：t值分彆為2.96、2.06；RT：t值分彆為3.19、2.34；均P＜0.05）；毛細血管型HCC與血竇型HCC的PE差異有統計學意義（t=2.51，P＜0.05）；毛細血管型HCC與混閤型HCC的PE差異無統計學意義；混閤型HCC與血竇型HCC的PE、WiR、WiPI、RT差異均無統計學意義。不同微血管形態分型HCC的WiAUC及MTT差異均無統計學意義。結論不同微血管形態分型HCC的CEUS定量參數差異顯著，可利用非入侵性的CEUS技術對HCC的微血管形態進行初步判斷。
목적：분석초성조영（CEUS）정량삼수여간세포암（HCC）미혈관형태적관계，탐토응용CEUS술전대HCC미혈관형태진행분형적가행성。방법회고성분석2010년4월지2011년12월우중산대학종류방치중심접수CEUS검사병행수술절제급병리증실적94례HCC환자，병탈궤채용SonoTumor연건행시간-강도곡선분석，연건자동획득봉치강도（PE）、상승시간（RT）、관주속솔（WiR）、관주지수（WiPI）、곡선하면적（WiAUC）화평균도월시간（MTT）。술후병리표본행CD34면역조화염색，대기진행미혈관형태분형。채용Fisher학절개솔법화χ2검험비교불동미혈관형태분형HCC환자림상삼수차이；채용단인소방차분석비교불동미혈관형태분형HCC적PE、RT、WiR、WiPI、WiAUC、MTT차이，진일보조간량량비교채용LSD-t검험。결과 CD34면역조화염색결과현시，94례HCC가분위모세혈관형28례、혈두형14례、혼합형52례。불동미혈관형태분형HCC환자적림상삼수차이균무통계학의의。모세혈관형HCC적PE、RT、WiR、WiPI、WiAUC화MTT분별위（4350.7±2566.0）a.u、（10.7±3.2）s、（717.0±489.9）a.u、（12820.3±8331.6）a.u、（128240.8±74487.1） a.u、（71.9±33.1）s，혈두형HCC분별위（2471.6±1107.1）a.u、（16.2±4.2）s、（321.9±171.8）a.u、（5561.4±2938.0）a.u、（86780.1±47563.7） a.u、（117.8±69.6）s，혼합형HCC분별위（3563.2±2343.1）a.u、（14.1±4.8）s、（519.4±403.2）a.u、（9015.3±6884.7）a.u、（110208.4±77511.3）a.u、（107.5±88.2）s。기중PE、WiR급WiPI정모세혈관형-혼합형-혈두형축점강저적추세，RT정모세혈관형-혼합형-혈두형축점증가적추세。모세혈관형HCC여혈두형、혼합형HCC적WiR、WiPI、RT차이균유통계학의의（WiR：t치분별위3.87、3.3；WiPI：t치분별위2.96、2.06；RT：t치분별위3.19、2.34；균P＜0.05）；모세혈관형HCC여혈두형HCC적PE차이유통계학의의（t=2.51，P＜0.05）；모세혈관형HCC여혼합형HCC적PE차이무통계학의의；혼합형HCC여혈두형HCC적PE、WiR、WiPI、RT차이균무통계학의의。불동미혈관형태분형HCC적WiAUC급MTT차이균무통계학의의。결론불동미혈관형태분형HCC적CEUS정량삼수차이현저，가이용비입침성적CEUS기술대HCC적미혈관형태진행초보판단。
Objective To explore the feasibility of contrast-enhanced ultrasonograhy (CEUS) in preoperative classification of hepatocellular carcinoma (HCC) microvascular morphology.Methods Totally 94 HCC patients who underwent CEUS were analyzed retrospectively. And the offline Time-intensity curve (TIC) were drawn using SonoTumor. The tumor size, alpha fetoprotein (AFP), cirrhosis, Child-Pugh classifi cation, tumor differentiation and TNM stage were statistically analyzed. The intratumoralmicrovessels of HCC in 94 cases were evaluated by CD34 immunohistochemical staining. The relationship between intratumoral microvessel morphology and CEUS parameters were analyzed.Results CD34 immunohistochemical staining showed three distinct microvessel types in 94 cases of HCC: 28 cases of capillary-like type, 14 cases of sinusoid-like type and 52 cases of mixed type. There were no significant differences of clinical data among three microvascular morphology types. The parameters of peak strength (PE), rise time (RT), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-in area under the curve (WiAUC) and mean transit time (MTT) in 28 cases of capillary-like type were (4350.7±2566.0) a.u, (10.7±3.2) s, (717.0±489.9) a.u, (12820.3±8331.6 )a.u, (128 240.8±74 487.1) a.u, (71.9±33.1)s. Those parameters in 14 cases of sinusoid-like type were (2471.6±1107.1) a.u, (16.2±4.2)s, (321.9±171) a.u, (5 561.4±2 938.0) a.u, (86 780.1±47 563.7) a.u, (117.8±69.6)s. And in 52 cases of mixed type they were (3563.2±2343.1) a.u, (14.1±4.8)s, (519.4±403.2) a.u, (9 015.3±6 884.7)a.u, (128 240.8±74 487.1) a.u, (71.9±33.1) s respectively. The CEUS parameters of WiR, WiPI in capillary-like type HCC patients were higher than sinusoid-like type and mixed type HCC patients, while RT was lower than sinusoid-like type and mixed type HCC patients, and the differences were signifi cant (WiR: t=3.87, 3.3, bothP=0.05; WiPI: t=2.96, 2.06, bothP=0.05; RT: t=3.19, 2.34, bothP=0.05). The parameter of PE in capillary-like type HCC patients were signifi cantly higher than that in sinusoid-like type HCC patients (t=2.51,P=0.05). And the parameter of PE in capillary-like type HCC patients was higher than mixed HCC patients, but there was no signifi cant difference. The parameters of PE, WiR and WiPI in mixed type HCC patients were higher than that in sinusoid-like type HCC patients, while RT in mixed type HCC patients were lower than that in sinusoid-like type HCC patients, but there were no signifi cant differences. No signifi cant differences of WiAUC and MTT were observed in HCC patients with different microvascular morphology.Conclusions There were signifi cant differences of CEUS parameters in different microvascular morphology types. And CEUS, as a non-invasive method, can be used for preliminary preoperative prediction of microvascular morphology in HCC patients.
