Zhang Yafang, Guo Zhi-Xing, Liao Ying, Yu Yiwen, Guo Ruohan, Han Xu, Lan Lilong, Zhou Jianhua
Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Pathology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Ultrasound Int Open. 2024 Jun 14;10:a23186654. doi: 10.1055/a-2318-6654. eCollection 2024.
This study aimed to compare contrast-enhanced ultrasound (CEUS) features of hepatic angiomyolipoma (HAML) and challenging cases of HCC, mainly those with no hepatitis infection but also with a low level of AFP (non-viral AFP- HCC). The study included pathologically confirmed HAMLs and non-viral AFP- HCCs undergoing CEUS from 2012 to 2023. Sonovue (SV) CEUS and Sonazoid (SZ) CEUS characteristics of the two groups were compared. The study included 50 HAMLs (24% on SZ-CEUS) and 88 non-viral AFP- HCCs (21.6% on SZ-CEUS). The CEUS characteristics on SZ-CEUS were similar to those on SV-CEUS to a certain extent. HAMLs more frequently displayed no washout and partial washout with partial no washout, so-called PWNW, in the late phase and post-vascular phase, whereas HCCs more commonly exhibited mild washout. In the post-vascular phase, all non-viral AFP- HCCs exhibited washout, thereby facilitating differentiation from no-washoutHAMLs, superior to SV-CEUS, where some non-viral AFP- HCCs still exhibited no washout in late phase that could not be distinguished from HAMLs. It is noteworthy that PWNW was exclusively found in nodules exhibiting hyper- and hypoechoic separation of the nodules, and hyper- and hypoechoic separation of HAMLs in the post-vascular phase on SZ-CEUS demonstrated PWNW more frequently compared to the late phase, which can potentially help distinguish nodules with hyper- and hypoechoic separation as either HAML or non-viral AFP- HCC. Conclusion: This study highlighted the usefulness of SV- and SZ-CEUS for distinguishing HAML and non-viral AFP- HCC and filled in existing gaps regarding the SZ-CEUS features of HAML.
本研究旨在比较肝血管平滑肌脂肪瘤（HAML）与具有挑战性的肝癌病例（主要是那些无肝炎感染且甲胎蛋白（AFP）水平较低的病例，即非病毒性AFP-HCC）的超声造影（CEUS）特征。该研究纳入了2012年至2023年期间接受CEUS检查且病理确诊的HAML和非病毒性AFP-HCC。比较了两组的声诺维（SV）CEUS和 SonoVue（SZ）CEUS特征。该研究纳入了50例HAML（24%在SZ-CEUS上）和88例非病毒性AFP-HCC（21.6%在SZ-CEUS上）。SZ-CEUS上的CEUS特征在一定程度上与SV-CEUS相似。HAML在晚期和血管后期更常表现为无消退和部分消退伴部分无消退，即所谓的PWNW，而肝癌更常见表现为轻度消退。在血管后期，所有非病毒性AFP-HCC均表现为消退，从而有助于与无消退的HAML相鉴别，优于SV-CEUS，在SV-CEUS中一些非病毒性AFP-HCC在晚期仍表现为无消退，无法与HAML区分。值得注意的是，PWNW仅在表现为结节高回声和低回声分离的结节中发现，并且在SZ-CEUS上，HAML在血管后期的高回声和低回声分离比晚期更频繁地表现出PWNW，这可能有助于区分具有高回声和低回声分离的结节是HAML还是非病毒性AFP-HCC。结论：本研究强调了SV-CEUS和SZ-CEUS在鉴别HAML和非病毒性AFP-HCC方面的有用性，并填补了关于HAML的SZ-CEUS特征的现有空白。
