Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China.
Ultrasound Med Biol. 2024 Jan;50(1):39-46. doi: 10.1016/j.ultrasmedbio.2023.08.022. Epub 2023 Sep 30.
The aim of the work described here was to evaluate the impact of hepatocellular carcinoma (HCC) tumor size on Sonazoid contrast-enhanced ultrasound (CEUS) enhancement features, especially in tumors with diameters ≤30 mm and <10 mm.
In this retrospective study, we included patients with histopathologically confirmed HCC lesions and divided them into three groups on the basis of tumor size. All patients underwent Sonazoid-enhanced CEUS examinations before surgery. B-mode ultrasound (BMUS) features and CEUS enhancement patterns were evaluated according to current World Federation for Ultrasound in Medicine and Biology Guidelines criteria. The χ- and Student t-tests were used to compare differences between groups.
We included 132 patients with histopathologically confirmed HCC lesions from November 2020 to September 2022. On the basis of tumor size, patients were divided into group 1 (<10 mm, n = 5), group 2 (10-30 mm, n = 54) and group 3 (>30 mm, n = 73). On BMUS, most HCCs appeared heterogeneous but predominantly hypo-echoic (61.4%, 81/132) with ill-defined margins and irregular shapes. Meanwhile, iso-echoic features were more common in small HCCs ≤30 mm (15.3%, 9/59), but a mixed hyper- and hypo-echoic appearance was more common in HCCs >30 mm (17.8%, 13/73) (p = 0.003). On Sonazoid-enhanced CEUS, all HCCs presented arterial phase hyperenhancement (APHE) (100.0%, 132/132). Most HCCs >30 mm exhibited heterogeneous hyperenhancement (86.3%, 63/73), whereas nearly one-third of small HCCs ≤30 mm exhibited homogeneous hyperenhancement (35.6%, 21/59) (p = 0.003). In the portal venous phase, there was a significantly higher proportion of washout in HCCs >30 mm (84.9%, 62/73) than in small HCCs ≤30 mm (64.4%, 38/59) (p = 0.006). During the Kupffer phase, 11 additional hypo-enhanced lesions (mean size: 14.1 ± 4.1 mm, iso-echoic on BMUS), which were also suspected to be HCC lesions, were detected in 5 patients with small HCCs ≤30 mm and 4 patients with HCCs >30 mm. All 5 cases of HCCs <10 mm exhibited APHE and late washout (>60 s). The majority (3/5, 60%) exhibited washout in the portal venous phase (70, 74 and 75 s), one case did so in the late phase (125 s) and another in the Kupffer phase (420 s).
Tumor size had a significant impact on the washout features of HCC lesions on Sonazoid-enhanced CEUS. Small HCC lesions ≤30 mm had a higher proportion of relatively late washout in comparison to larger lesions. Sonazoid-enhanced CEUS might be helpful in the detection and characterization of HCC lesions <10 mm.
本研究旨在评估肝细胞癌（HCC）肿瘤大小对 SonoVue 超声造影（CEUS）增强特征的影响，特别是在直径≤30mm 和<10mm 的肿瘤中。
本回顾性研究纳入了经组织病理学证实的 HCC 病变患者，并根据肿瘤大小将其分为三组。所有患者均在术前接受 SonoVue 增强 CEUS 检查。根据当前的世界超声医学与生物学联合会指南标准，评估 B 型超声（BMUS）特征和 CEUS 增强模式。采用 χ 2 和 Student t 检验比较组间差异。
我们纳入了 2020 年 11 月至 2022 年 9 月期间经组织病理学证实的 HCC 病变患者 132 例。根据肿瘤大小，患者被分为组 1（<10mm，n=5）、组 2（10-30mm，n=54）和组 3（>30mm，n=73）。在 BMUS 上，大多数 HCC 呈异质性表现，但主要呈低回声（61.4%，81/132），边界不清，形状不规则。同时，小 HCCs（≤30mm）中更常见等回声特征（15.3%，9/59），但大 HCCs（>30mm）中更常见混合高、低回声表现（17.8%，13/73）（p=0.003）。在 SonoVue 增强 CEUS 上，所有 HCC 均表现为动脉期高增强（APHE）（100.0%，132/132）。大多数>30mm 的 HCC 表现为不均匀高增强（86.3%，63/73），而近三分之一的小 HCCs（≤30mm）表现为均匀高增强（35.6%，21/59）（p=0.003）。在门静脉期，>30mm 的 HCC 中明显有更高比例的廓清（84.9%，62/73），而小 HCCs（≤30mm）中则为 64.4%（38/59）（p=0.006）。在 Kupffer 期，在 5 例小 HCCs（≤30mm）和 4 例 HCCs（>30mm）中，还检测到 11 个额外的低增强病变（平均大小：14.1±4.1mm，在 BMUS 上呈等回声），这些病变也疑似 HCC 病变。所有<10mm 的 HCC 病例均表现为 APHE 和晚期廓清（>60s）。其中 3 例（60%）在门静脉期有廓清（70、74 和 75s），1 例在晚期廓清（125s），另 1 例在 Kupffer 期廓清（420s）。
肿瘤大小对 SonoVue 增强 CEUS 中 HCC 病变的廓清特征有显著影响。与大肿瘤相比，小 HCCs（≤30mm）的廓清时间相对较晚。SonoVue 增强 CEUS 可能有助于发现和诊断<10mm 的 HCC 病变。
