Differential diagnosis of PHC and HCH by CEUS and analysis of risk factors for tumor metastasis
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摘要:
目的研究超声造影（CEUS）对病灶内部、周围血流信号对原发性肝癌（PHC）以及肝血管瘤（HCH）的鉴别诊断能力，并分析PHC患者肿瘤发生转移的危险因素。 方法选择2019年2月~2020年12月的65例肝脏肿瘤患者作为研究对象，PHC患者35例，HCH患者30例。分别对两组患者进行CEUS检查，比较两组患者肿瘤病灶部位内部以及周围血流信号，以及相关超声指标包括增始时间、峰值时间、峰值增强强度、增强速率以及50%倾斜率的差异。比较PHC患者中不同转移情况组患者的临床资料、肿瘤病灶部位内部以及周围血流信号，以及相关超声指标差异，采用多因素logistic分析肿瘤发生转移的危险因素。 结果PHC组和HCH组患者肿瘤病灶部位内部以及周围血流信号上的差异有统计学意义（P < 0.05）。PHC患者的增始时间、峰值时间、增强速率高于HCH患者，峰值增强强度以及50%倾斜率低于HCH患者（P < 0.05）。转移组与未转移组在患者的年龄、肿瘤数量、肿瘤分期上的差异有统计学意义（P < 0.05），在性别、BMI、肿瘤直径上差异无统计学意义（P > 0.05）。转移组患者与未转移组患者的血流信号的差异有统计学意义（P < 0.05）；转移组患者的增始时间、峰值时间、增强速率高于未转移组患者，峰值增强强度以及50%倾斜率低于未转移组患者，差异有统计学意义（P < 0.05）。年龄、肿瘤数量、肿瘤分期、血流信号、倾斜率、峰值增强强度、增始时间、峰值时间、增强速率均为PHC患者肿瘤发生转移的独立危险因素。 结论通过对患者的超声造影检查，可有效对PHC以及HCH进行鉴别诊断，同时，年龄、肿瘤数量、肿瘤分期以及超声造影指标均可影响患者的肿瘤转移风险。 Abstract:ObjectiveTo explore the ability of contrast- enhanced ultrasound (CEUS) in the differential diagnosis of primary hepatocellular carcinoma (PHC) and hepatic hemangioma (HCH) by blood flow signals inside and around the lesion, and analyze the risk factors of tumor metastasis in PHC patients. MethodsSixty-five patients with liver tumors from February 2019 to December 2020 were selected as the study subjects, including 35 patients with PHC and 30 patients with HCH. CEUS examinations were performed on the two groups of patients, and the blood flow signals inside and around the tumor lesions of the two groups were compared, as well as related ultrasound indicators including the increase time, peak time, peak enhancement intensity, enhancement rate and 50% tilt rate. The differences in the clinical data, the blood flow signals inside and around the tumor lesions, and related ultrasound indexes of patients in different metastasis groups in PHC patients were compared. In addition, the risk factors of tumor metastasis were analyzed by multivariate logistic. ResultsThe differences in blood flow signals inside and around the tumor lesion in the PHC group and the HCH group were significant (P < 0.05). The increase time, peak time and enhancement rate of PHC patients were significantly higher than those of HCH patients(P < 0.05). The peak enhancement intensity and 50% tilt rate were significantly lower than those of HCH patients(P < 0.05). There were significant differences in terms of age, number of tumors and tumor stage between the metastatic group and the nonmetastatic group (P < 0.05), but the differences in gender, body mass index and tumor diameter were no significant (P > 0.05). The difference in blood flow signals inside and around the tumor lesion between the metastatic group and the non- metastatic group was significant (P < 0.05). The increase time, peak time and enhancement rate of patients in the metastasis group were significantly higher than those in the non-metastasis group, and the peak enhancement intensity and 50% tilt rate of metastasis group were significantly lower than those of non-metastasis group, and the difference was statistically significant (P < 0.05). The age, number of tumors, stage of tumors, blood flow signal, 50% tilt rate, peak enhancement intensity, increase time, peak time and enhancement rate were all independent risk factors for tumor metastasis in PHC patients. ConclusionCEUS can effectively differentiate PHC and HCH. The age, number of tumors, stage of tumors and related ultrasound indicators can affect the risk of tumor metastasis. -
表 1 两组患者的肿瘤病灶部位内部以及周围血流信号比较
Table 1. Comparison of blood flow signals inside and around the tumor lesions of the two groups of patients [n(%)]
组别 血流分级 0 Ⅰ Ⅱ Ⅲ PHC组（n=35） 2(5.71) 3(8.57) 24(68.57) 6(17.14) HCH组（n=30） 8(26.66) 7(23.33) 8(26.66) 7(23.33) χ2 12.969 P 0.005 
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表 2 两组患者的增始时间、峰值时间、峰值增强强度、增强速率以及50%倾斜率比较
Table 2. Comparison of onset time, peak time, peak enhancement intensity, enhancement rate and 50% slope rate of the two groups of patients (Mean±SD)
组别 增始时间（s） 峰值时间（s） 峰值增强强度 增强速率 50%倾斜率 PHC组（n=35） 14.58±2.44 36.78±2.16 8.76±2.42 0.83±0.26 0.57±0.32 HCH组（n=30） 11.34±2.52 44.18±2.53 12.49±2.55 0.63±0.17 0.88±0.45 t 5.257 12.723 6.043 3.717 3.233 P 0.000 0.000 0.000 0.000 0.002
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表 3 PHC患者转移组与未转移组基础资料比较
Table 3. Comparison of basic data between the metastatic group and the non-metastatic group of PHC patients (Mean±SD)
组别 性别（男/女） 年龄（岁） BMI（kg/m2） 肿瘤数量（个） 肿瘤直径（mm） 肿瘤分期（Ⅰ~Ⅱ/Ⅲ~Ⅳ） 转移组（n=15） 8/7 48.52±2.91 24.19±2.51 3.26±0.16 21.32±2.12 6/9 未转移组（n=20） 12/8 46.33±2.19 24.09±2.40 2.36±0.41 21.09±2.11 15/5 χ2/t 0.162 2.544 0.120 8.950 0.318 4.381 P 0.693 0.016 0.906 0.000 0.752 0.036
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表 4 PHC患者转移组与未转移组的血流信号比较
Table 4. Comparison of blood flow signals between the metastatic group and the non-metastatic group of PHC patients [n(%)]
组别 血流分级 0 Ⅰ Ⅱ Ⅲ 转移组（n=15） 4(26.67) 2(13.33) 3(20.00) 6(40.00) 未转移组（n=20） 2(10.00) 15(75.00) 2(10.00) 1(5.00) χ2 13.950 P 0.003
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表 5 PHC患者转移组与未转移组的超声造影指标分析
Table 5. Analysis of CEUS indexes of metastatic group and non-metastatic group of PHC patients (Mean±SD)
组别 增始时间（s） 峰值时间（s） 峰值增强强度 增强速率 50%倾斜率 转移组（n=15） 15.22±1.23 35.11±1.54 7.07±1.03 0.91±0.11 0.51±0.18 未转移组（n=20） 13.45±1.01 37.34±1.17 9.11±1.09 0.79±0.14 0.62±0.10 t 4.674 4.874 5.608 2.742 2.133 P < 0.001 < 0.001 < 0.001 0.010 0.046
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表 6 PHC患者肿瘤转移的多因素分析
Table 6. Multivariate analysis of tumor metastasis in PHC patients
因素 β S.E. Wald P OR 95%CI 年龄 1.02 2.36 1.32 0.00 1.02 0.90~1.93 肿瘤数量 1.06 3.27 1.33 0.00 1.63 1.33~2.32 肿瘤分期 0.37 4.14 1.69 0.00 1.09 0.63~2.07 血流信号 0.19 3.64 1.85 0.02 1.36 1.03~14.32 增始时间 0.12 3.26 1.77 0.00 1.26 1.09~2.97 峰值时间 0.15 3.29 1.52 0.00 1.52 1.01~2.99 增强速率 0.26 3.99 1.78 0.00 1.57 1.00~3.64 峰值增强强度 0.22 4.12 1.25 0.00 0.48 1.00~6.12 50%倾斜率 0.58 4.52 1.52 0.00 0.52 1.06~4.51
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[1] 徐秀梅, 王蓓, 周娜, 等. 实时二维超声造影对原发性肝癌周边转移灶的诊断研究[J]. 临床和实验医学杂志, 2018, 17(10): 1046-9. doi: 10.3969/j.issn.1671-4695.2018.10.013 [2] 王蓓, 张立平, 翟虹. 实时动态三维超声造影评价索拉非尼靶向治疗中晚期肝癌早期疗效的观察性研究[J]. 中国医药, 2018, 13(2): 235-9. doi: 10.3760/cma.j.issn.1673-4777.2018.02.019 [3] 汤晓艳. 超声造影在肝癌介入治疗中的应用价值[J]. 实用癌症杂志, 2018, 33(5): 781-3. doi: 10.3969/j.issn.1001-5930.2018.05.025 [4] 董杰. 原发性肝癌的影像学诊断进展[J]. 河南医学研究, 2011, 20 (3): 367-70. doi: 10.3969/j.issn.1004-437X.2011.03.041 [5] 战勇, 于晓玲, 梁萍, 等. 常规超声及超声造影在肝脏占位性病变穿刺活检中的应用价值[J]. 中国医疗设备, 2014, 29(2): 164-7. doi: 10.3969/j.issn.1674-1633.2014.02.060 [6] 袁月德, 刘梅存. 三维彩色多普勒超声与超声造影对鉴别诊断原发性肝癌及转移性肝癌的价值[J]. 中国医疗设备, 2018, 33(6): 78-81. doi: 10.3969/j.issn.1674-1633.2018.06.020 [7] 林洁. 彩色多普勒超声对不同类型肝癌诊断及术后随访的价值[J]. 江苏医药, 2018, 44(6): 689-91. https://www.cnki.com.cn/Article/CJFDTOTAL-YIYA201806026.htm [8] 周永昌, 郭万学. 超声医学[M]. 5版. 北京: 科学技术文献出版社, 2006. [9] 徐海珊, 范小明, 汤富刚, 等. 灰阶超声造影在肝脏局灶性病变诊断中的应用[J]. 全科医学临床与教育, 2007, 5(1): 39-41. doi: 10.3969/j.issn.1672-3686.2007.01.014 [10] 孙厚坦, 赵威武, 陈朝旻, 等. 经皮门静脉超声造影评价肝癌TACE疗效的初步应用[J]. 西北国防医学杂志, 2018, 39(10): 666-70. https://www.cnki.com.cn/Article/CJFDTOTAL-XBGY201810012.htm [11] 何燕莲, 余岳芬, 刘振华. 超声造影时间-强度曲线评价射频消融治疗肝癌的应用价值[J]. 现代中西医结合杂志, 2018, 27(24): 2725-8. doi: 10.3969/j.issn.1008-8849.2018.24.033 [12] 赵玉丹. 超声造影与彩色多普勒超声诊断肝脏占位性病变的价值[J]. 医疗装备, 2019, 32(18): 21-2. doi: 10.3969/j.issn.1002-2376.2019.18.013 [13] 曹佳颖, 范培丽, 董怡, 等. 二维与三维超声造影定量分析技术评估肝肿瘤的对比研究[J]. 中华超声影像学杂志, 2018, 27(5): 397-400. doi: 10.3760/cma.j.issn.1004-4477.2018.05.006 [14] 朱玉鹏, 张德智, 祝英乔. 基于磁定位导航的影像融合联合针尖追踪技术引导微波消融治疗肝脏肿瘤1例[J]. 中国介入影像与治疗学, 2018, 15(1): 63-4. https://www.cnki.com.cn/Article/CJFDTOTAL-JRYX201801024.htm [15] 雒大健, 全艳, 张志勇. 超声造影与彩色多普勒超声在肝实质性肿块诊断中的对比研究[J]. 中国超声医学杂志, 2018, 34(8): 701-5. doi: 10.3969/j.issn.1002-0101.2018.08.009 [16] 王心佳. 超声弹性成像与超声造影用于临床诊断肝肿瘤的价值探讨[J]. 中国保健营养, 2018, 28(10): 15-6. https://www.cnki.com.cn/Article/CJFDTOTAL-ZUAN201811021.htm [17] 胡永胜, 朱宇, 徐毅. 实时超声造影在肝脏良恶性病变鉴别诊断中的应用价值分析[J]. 实用肝脏病杂志, 2015, 18(2): 197-8. doi: 10.3969/j.issn.1672-5069.2015.02.025 [18] Chen LD, Ruan SM, Liang JY, et al. Differentiation of intrahepatic cholangiocarcinoma from hepatocellular carcinoma in high-risk patients: a predictive model using contrast-enhanced ultrasound[J]. World J Gastroenterol, 2018, 24(33): 3786-98. doi: 10.3748/wjg.v24.i33.3786 [19] 雒大健, 张志勇, 杨桃, 等. 超声造影在肝癌介入干预效果评价中的应用价值研究[J]. 中国实验诊断学, 2017, 21(1): 54-6. doi: 10.3969/j.issn.1007-4287.2017.01.018 [20] Bo XW, Xu HX, Guo LH, et al. Ablative safety margin depicted by fusion imaging with post-treatment contrast-enhanced ultrasound and pre-treatment CECT/CEMRI after radiofrequency ablation for liver cancers[J]. Br J Radiol, 2017, 90(1078): 20170063. doi: 10.1259/bjr.20170063 [21] Schellhaas B, Pfeifer L, Kielisch C, et al. Interobserver agreement for contrast-enhanced ultrasound (CEUS)-based standardized algorithms for the diagnosis of hepatocellular carcinoma in high-risk patients[J]. Ultraschall Med, 2018, 39(6): 667-74. doi: 10.1055/a-0612-7887 [22] Wiesinger I, Wiggermann P, Zausig N, et al. Percutaneous treatment of malignant liver lesions: evaluation of success using contrastenhanced ultrasound (CEUS) and perfusion software[J]. Ultraschall Med, 2018, 39(4): 440-7. doi: 10.1055/s-0043-119353 [23] Sperandeo M, Rea G, Grimaldi MA, et al. Contrast-enhanced ultrasound does not discriminate between community acquired pneumonia and lung cancer[J]. Thorax, 2017, 72(2): 178-80. doi: 10.1136/thoraxjnl-2016-208913 [24] Ran L, Zhao W, Zhao Y, et al. Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP): a systematic review and a meta-analysis[J]. Medicine: Madr, 2017, 96 (28): e7463. http://pubmedcentralcanada.ca/pmcc/articles/PMC5515757/ [25] Masumoto N, Kadoya T, Murakami C, et al. Abstract P4-02-06: Evaluation of contrast-enhanced ultrasonography for early prediction of response to neoadjuvant chemotherapy in triple negative breast cancer[C]//Poster Session Abstracts. American Association for Cancer Research, 2017, 77(4): 4. -
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