van Vledder Mark G, Torbenson Michael S, Pawlik Timothy M, Boctor Emad M, Hamper Ulrike M, Olino Kelly, Choti Michael A
Department of Surgery, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA.
Arch Surg. 2010 Jul;145(7):661-7. doi: 10.1001/archsurg.2010.124.
To investigate the association of relative tumor echogenicity and hepatic steatosis in patients undergoing resection of colorectal liver metastases (CRLM).
Prospective study.
The Johns Hopkins Hospital.
A total of 126 patients undergoing liver surgery for CRLM from January 1, 1998, through December 31, 2008, in whom 191 lesions had complete intraoperative ultrasonography images for review and adequate linked pathological data available.
The intraoperative ultrasonography images were reviewed and scored for echogenicity (hypoechoic, isoechoic, or hyperechoic). In addition, a histopathologic review of the nontumorous liver tissue was performed, and the extent of steatosis was scored and correlated with tumor echogenicity.
Of the patients undergoing surgery, 49 (38.8%) were found to have mild to severe steatosis. Of the 191 total CRLM visualized by intraoperative ultrasonography, 91 (47.6%) were found to be hypoechoic, 65 (34.0%) were isoechoic, and 35 (18.3%) were hyperechoic. In patients with steatosis, lesions were significantly more likely to be hypoechoic when compared with patients without steatosis (odds ratio, 4.17; 95% confidence interval, 1.87-8.47; P = .001). Echogenicity was independent of the cause of steatosis or response to chemotherapy.
The echogenicity of CRLM was significantly affected by the presence of liver steatosis, with decreased echogenicity and increased conspicuity of lesions despite overall poorer image quality. These findings might reinforce the usefulness of intraoperative ultrasonography in identifying additional CRLM in patients undergoing surgical therapy, even in those with fatty liver tissue.
研究接受结直肠癌肝转移（CRLM）切除术患者的肿瘤相对回声性与肝脂肪变性之间的关联。
前瞻性研究。
约翰霍普金斯医院。
1998年1月1日至2008年12月31日期间，共有126例因CRLM接受肝脏手术的患者，其中191个病灶有完整的术中超声图像可供复查且有充分的相关病理数据。
复查术中超声图像并对回声性进行评分（低回声、等回声或高回声）。此外，对非肿瘤性肝组织进行组织病理学检查，对脂肪变性程度进行评分并与肿瘤回声性相关联。
接受手术的患者中，49例（38.8%）被发现有轻度至重度脂肪变性。在术中超声检查可见的191个CRLM病灶中，91个（47.6%）为低回声，65个（34.0%）为等回声，35个（18.3%）为高回声。与无脂肪变性的患者相比，有脂肪变性的患者病灶更可能为低回声（优势比，4.17；95%置信区间，1.87 - 8.47；P = 0.001）。回声性与脂肪变性的原因或化疗反应无关。
CRLM的回声性受肝脏脂肪变性的显著影响，尽管整体图像质量较差，但病灶回声性降低且清晰度增加。这些发现可能会加强术中超声在识别接受手术治疗患者中额外CRLM的作用，即使是在有脂肪肝组织的患者中。
