Division of Hepato-Biliary-Pancreatic , Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
AJR Am J Roentgenol. 2011 Jun;196(6):1314-21. doi: 10.2214/AJR.10.4310.
Our aim was to accurately assess the correlation between findings of contrast-enhanced intraoperative ultrasound using Sonazoid and histologic grade of hepatocellular carcinoma (HCC).
We enrolled 239 consecutive patients who were undergoing surgery for HCC for this study. Because 33 extensively necrotic HCCs were excluded, a total of 374 histologically proven HCCs were detected in all resected specimens and were the study subjects (71 well-differentiated, 239 moderately differentiated, and 64 poorly differentiated HCCs). After a laparotomy and liver mobilization, contrast-enhanced intraoperative ultrasound in the harmonic mode was performed after a Sonazoid injection. The first minute was defined as the vascular phase, in which the vascularity of the 239 HCCs was assessed. After an approximately 15-minute delay, a thorough liver exploration was performed (Kupffer phase). Preoperative dynamic CT was routinely performed, and the findings were assessed for reference.
The proportion of hypervascular tumors during the vascular phase tended to be lower among well-differentiated than among moderately and poorly differentiated HCCs (66% vs 80%, p = 0.058). The proportion of hypoechoic tumors during the Kupffer phase was significantly lower among well-differentiated than among moderately and poorly differentiated HCCs (54% vs 92%, p < 0.0001). In dynamic CT, the proportions of hypervascular tumors during the early phase and hypodense tumors during the late phase were significantly lower among well-differentiated HCCs than among moderately and poorly differentiated HCCs, respectively (early phase, 51% vs 87%, p < 0.0001; late phase, 59% vs 85%, p < 0.0001).
Contrast-enhanced intraoperative ultrasound using Sonazoid is useful for estimating the histologic grade of HCC.
本研究旨在准确评估 SonoVue 增强术中超声与肝细胞癌（HCC）组织学分级之间的相关性。
本研究纳入了 239 例因 HCC 接受手术的连续患者。由于排除了 33 例广泛坏死的 HCC，因此在所有切除标本中总共检测到 374 例经组织学证实的 HCC，这些 HCC 为研究对象（71 例分化良好、239 例中分化、64 例低分化 HCC）。剖腹术和肝游离后，在 SonoVue 注射后进行谐波模式的增强术中超声。第 1 分钟定义为血管相，评估 239 例 HCC 的血管生成。大约 15 分钟后，进行彻底的肝脏探查（Kupffer 相）。常规进行术前动态 CT，评估结果以供参考。
在血管相期间，高血管肿瘤的比例在分化良好的 HCC 中低于中分化和低分化 HCC（66%比 80%，p=0.058）。在 Kupffer 相中，低回声肿瘤的比例在分化良好的 HCC 中明显低于中分化和低分化 HCC（54%比 92%，p<0.0001）。在动态 CT 中，在早期相期间高血管肿瘤的比例和在晚期相期间低衰减肿瘤的比例在分化良好的 HCC 中明显低于中分化和低分化 HCC（早期相，51%比 87%，p<0.0001；晚期相，59%比 85%，p<0.0001）。
SonoVue 增强术中超声对估计 HCC 的组织学分级有用。
