Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, China.
Clin Hemorheol Microcirc. 2024;87(1):55-65. doi: 10.3233/CH-231944.
Hepatic sarcomatoid carcinoma (HSC) is a rare malignancy of the liver. The ultrasound and clinical features of HSC have not been determined.
To investigate and compare the ultrasound and clinical features of HSC and hepatocellular carcinoma (HCC), and to reveal the valuable features of HSC.
The ultrasound features and clinical data of pathologically proven HSC (n = 37) were compared with HCC (n = 92) in a matching ratio of 1:4 using the propensity score (age, gender and tumor size).
The HSC patients were more likely to accompany with clinical symptoms and vascular invasion than HCC patients (40.5% vs 17.4%, 24.3% vs 6.5%, P < 0.05). The size of HSCs was significantly larger than that of HCCs (P < 0.05). The proportion of patients with elevated alpha-fetoprotein was significantly lower in HSC (35.1% vs 54.3%, P < 0.05). On gray-scale ultrasound images, the HSCs were more likely to demonstrate as indistinct margin and irregular shape lesions compared to HCCs (78.4% vs 48.8%; 70.3% vs 23.9%, P < 0.05). Under color Doppler flow imaging (CDFI), the blood flow signals were more frequently detected in HSC lesions (75.7% vs 56.5%, P < 0.05). Resistance index (RI) was higher in HSCs than in HCCs [0.78 (0.70,0.82) vs 0.70 (0.62,0.76), P < 0.05]. On contrast-enhanced ultrasound (CEUS), HSCs mainly showed entirety heterogeneous hyper-enhancement (48.6%), entirety homogeneous enhancement (18.9%), peripheral and internal septal enhancement (18.9%). The incidence of non-enhanced areas inside HSC lesions was higher than that inside HCC lesions (56.8% vs 31.5%, P < 0.05). During the portal venous and late phases, most of the lesions revealed hypo-enhancement in both groups, whereas earlier washout was observed in HSCs [43.0 s (30.5,58.0) vs 60.0 s (46.3,100.0), P < 0.05].
CEUS features are useful in preoperative and non-invasive differentiation of hepatic sarcomatoid carcinoma and hepatocellular carcinoma.
肝肉瘤样癌（HSC）是一种罕见的肝脏恶性肿瘤。HSC 的超声和临床特征尚未确定。
探讨和比较 HSC 和肝细胞癌（HCC）的超声和临床特征，揭示 HSC 的有价值特征。
采用倾向性评分（年龄、性别和肿瘤大小），将病理证实的 HSC（n=37）的超声特征和临床资料与 HCC（n=92）进行 1:4 匹配比较。
HSC 患者比 HCC 患者更易伴有临床症状和血管侵犯（40.5%比 17.4%，24.3%比 6.5%，P<0.05）。HSCs 的大小明显大于 HCCs（P<0.05）。HSC 患者中甲胎蛋白升高的比例明显低于 HCC（35.1%比 54.3%，P<0.05）。在灰阶超声图像上，HSC 比 HCC 更易表现为边界不清和形态不规则的病变（78.4%比 48.8%；70.3%比 23.9%，P<0.05）。在彩色多普勒血流成像（CDFI）下，HSC 病变中血流信号更频繁地被检测到（75.7%比 56.5%，P<0.05）。HSCs 的阻力指数（RI）高于 HCCs [0.78（0.70，0.82）比 0.70（0.62，0.76），P<0.05]。在对比增强超声（CEUS）中，HSCs 主要表现为整体不均匀强化（48.6%）、整体均匀强化（18.9%）、周边和内部间隔强化（18.9%）。HSC 病变内无增强区的发生率高于 HCC 病变内（56.8%比 31.5%，P<0.05）。在门静脉期和延迟期，两组病变均呈低增强，而 HSCs 则呈早期洗脱[43.0 s（30.5，58.0）比 60.0 s（46.3，100.0），P<0.05]。
CEUS 特征有助于术前和非侵入性鉴别肝肉瘤样癌和肝细胞癌。
