Department of Internal Medicine 1, Universitätsklinikum Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nurnberg, Erlangen, Germany.
Clin Hemorheol Microcirc. 2023;84(4):413-424. doi: 10.3233/CH-231740.
Non-invasive diagnosis of hepatocellular carcinoma (HCC) in contrast-enhanced ultrasound (CEUS) is based on the combination of arterial phase hyperenhancement (APHE) and subsequent late (>60 seconds) and mild contrast washout (WO). Whereas APHE is seen in the majority of HCC, wash-out pattern may vary in onset and intensity. In some HCC lesions, even no washout is seen at all.
Our prospective multicentre DEGUM HCC CEUS study aimed at identifying typical and atypical washout appearance of HCC in a real-life setting.
High-risked patients for HCC with focal liver lesions upon B-mode ultrasound were recruited prospectively. In a multicentre real-life setting, a standardised CEUS examination including an extended late phase up to 6 minutes was performed. CEUS patterns of HCC were recorded, and onset and intensity of washout appearance were assessed with respect to patient and tumour characteristics. Histological findings served as reference standard.
In 230/316 HCC (72.8%), a CEUS pattern of APHE followed by WO was observed. In 158 cases (68.7%), WO was typical (onset > 60 seconds, mild intensity). 72 cases (31.3%) showed marked and / or early WO, whereas in 41 HCCs (13%), APHE was followed by sustained isoenhancement.Atypical WO upon CEUS was associated with macroinvasion of the liver vessels, portal vein thrombosis and diffuse growth pattern, but not tumour size and histological grading.
In a prospective multicentre real-life setting, APHE is followed by atypical washout appearance or no washout at all in almost half of the HCCs with APHE. The examiner has to bear in mind that in spite of a characteristic APHE in HCCs, washout appearance can be atypical in CEUS, especially in HCCs with macrovascular invasion or diffuse growth pattern.
在对比增强超声（CEUS）中，肝细胞癌（HCC）的非侵入性诊断基于动脉期高增强（APHE）与随后的晚期（>60 秒）和轻度对比消退（WO）的结合。虽然大多数 HCC 中可见 APHE，但消退模式在开始和强度上可能有所不同。在一些 HCC 病变中，甚至根本没有消退。
我们的前瞻性多中心 DEGUM HCC CEUS 研究旨在在真实环境中识别 HCC 的典型和非典型消退表现。
对经 B 型超声检查发现局灶性肝脏病变的高危 HCC 患者进行前瞻性招募。在多中心真实环境中，进行标准化的 CEUS 检查，包括扩展的晚期相，最长可达 6 分钟。记录 HCC 的 CEUS 模式，并根据患者和肿瘤特征评估消退外观的开始和强度。组织学发现作为参考标准。
在 230/316 例 HCC（72.8%）中，观察到 APHE 后 WO 的 CEUS 模式。在 158 例（68.7%）中，WO 为典型（开始时间>60 秒，强度轻微）。72 例（31.3%）表现为明显和/或早期 WO，而在 41 例 HCC 中（13%），APHE 后为持续等增强。CEUS 上的非典型 WO 与肝血管的巨浸润、门静脉血栓形成和弥漫性生长模式有关，但与肿瘤大小和组织学分级无关。
在前瞻性多中心真实环境中，近一半的 APHE 后 HCC 出现非典型消退外观或根本没有消退。检查者必须记住，尽管 HCC 中存在特征性的 APHE，但在 CEUS 中消退外观可能是非典型的，特别是在有巨血管浸润或弥漫性生长模式的 HCC 中。
