Jin Chen, Zhang Xiao-Yun, Li Jia-Wu, Li Chuan, Peng Wei, Wen Tian-Fu, Luo Yan, Lu Qiang, Zhong Xiao-Fei, Zhang Jing-Yi, Yan Lv-Nan, Yang Jia-Yin
Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Sonography, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Oncotarget. 2017 Jul 27;8(48):83698-83711. doi: 10.18632/oncotarget.19624. eCollection 2017 Oct 13.
The aim of this study was to investigate the role of contrast-enhanced ultrasound (CEUS) in differentiating hepatocellular carcinoma (HCC) intrahepatic cholangiocarcinoma (ICC) and primary liver cancer benign liver lesions for surgical decision making.
Data from 328 patients (296 primary liver cancer patients: 232 HCC and 64 ICC patients and 32 benign hepatic lesion patients) who underwent hepatectomy at our center were retrospectively collected from 2010 to 2015. Conventional ultrasound (US) and CEUS were performed for all patients before hepatectomy. Enhancement patterns in CEUS were classified and compared for HCC . ICC and for primary liver cancer . benign lesions.
Primary liver cancer and hepatic benign lesions could be distinguished by CEUS in different phases. The most obvious differences were in the portal and delayed phases, in which benign lesions could still show hyperenhancement (46.9% . 0.0% and < 0.001 in the portal phase; 43.7% . 0.0% and < 0.001 in the delayed phase). For differentiating HCC and ICC, our results revealed that HCC and ICC displayed different enhancement patterns in the arterial phase ( < 0.001) and the portal phase ( < 0.001). In the subgroup analyses, both HCC and ICC showed a high rate of homogeneous hyperenhancement during the arterial phase when tumors were ≤5 cm (87.2% . 64.0% and = 0.008) or the Ishak score was ≥5 (75.8% vs. 42.9% and = 0.023), although there was statistical difference. However, during the portal phase, ICC > 5 cm showed significantly more frequent hypoenhancement (92.3% . 54.5% and < 0.001) and less isoenhancement (7.7% . 45.5% and < 0.001) than HCC; additionally, during the portal phase, there was no statistical difference in the enhancement patterns of ICC with different hepatic backgrounds.
Tumor size and hepatic background should be taken into consideration when distinguishing HCC and ICC before surgery. However, CEUS is a helpful tool for differentiating malignant and benign hepatic lesions. For patients who require surgical treatment, CEUS may help with surgical decision making.
本研究旨在探讨超声造影（CEUS）在鉴别肝细胞癌（HCC）、肝内胆管癌（ICC）及原发性肝癌与肝脏良性病变以辅助手术决策中的作用。
回顾性收集2010年至2015年在本中心接受肝切除术的328例患者的数据（296例原发性肝癌患者：232例HCC患者和64例ICC患者，以及32例肝脏良性病变患者）。所有患者在肝切除术前均接受了常规超声（US）和CEUS检查。对HCC、ICC以及原发性肝癌与良性病变的CEUS增强模式进行分类和比较。
原发性肝癌与肝脏良性病变可通过CEUS在不同阶段进行区分。最明显的差异出现在门脉期和延迟期，其中良性病变在这两个时期仍可表现为高增强（门脉期：46.9%对0.0%，P<0.001；延迟期：43.7%对0.0%，P<0.001）。对于鉴别HCC和ICC，结果显示HCC和ICC在动脉期（P<0.001）和门脉期（P<0.001）表现出不同的增强模式。在亚组分析中，当肿瘤≤5 cm（87.2%对64.0%，P = .008）或伊沙克评分≥5时（75.8%对42.9%，P = .023），HCC和ICC在动脉期均显示出较高的均匀高增强率，尽管存在统计学差异。然而，在门脉期，>5 cm的ICC显示出比HCC更频繁的低增强（92.3%对54.5%，P<0.001）和更少的等增强（7.7%对45.5%，P<0.001）；此外，在门脉期，不同肝脏背景的ICC增强模式无统计学差异。
术前鉴别HCC和ICC时应考虑肿瘤大小和肝脏背景。然而，CEUS是鉴别肝脏恶性和良性病变的有用工具。对于需要手术治疗的患者，CEUS可能有助于手术决策。
