Evaluation Of Hepatocellular Carcinoma Using Contrast-enhanced Ultrasound: Correlation With Cellular Differentiation

Objective:To observe the appearance and the characterization in every vascular phase of hepatocellular carcinoma(HCC)with contrast-enhanced ultrasound(CEUS);to evaluate the relationship between the characteristic of enhanced-ultrasonography of HCC and tumor differentiation by using CEUS.Methods44 patients with a total of 44 HCC lesions(including 18 well differentiated HCCs,15 moderately differentiated HCCs,11 poorly differentiated HCCs) underwent examination of CEUS before the surgical operation in a week.CEUS was performed with SonoVue and pulse-inversion harmonic imaging(PIHI).The blood perfusion characteristics of tumors were observed after the injection of contrast ultrasound agent(SonoVue).The time-intensity curve of every nodule was draw by QLab software(PHILIPS IU22)and parameters of the time-intensity curve during contrast enhancement period(enhancement beginning time,peak intensity time,and enhancement time)were analyzed.ResultsThe size of well,moderately and poorly differentiated HCCs was(6.454±3.42)cm,(8.59±3.16)cm,(9.07±3.30)cm respectively.There was no statistical significance in the sizes with different histopathologic grading(P＞0.05). Significant difference of the blood flow grade was observed between well differentiated and poorly differentiated HCCs(P＜0.05).No significant difference in blood flow grade was observed between well-differentiated and moderately differentiated HCCs,and between moderately differentiated and poorly differentiated HCCs.In the arterial phase,43 HCCs showed fast enhancement.Then the echo level of the tumor area decreased gradually compared with that of the surrounding tissue.In the late phase,6 HCCs was visualized as isoechoic or appreciably hypoechoic lesion and 38 HCCs was visualized as obviously hypoechoic lesion.Peak intensity time in well,moderately,poorly differentiated HCC were(31.17±5.89)s,(28.53±8.06)s,(21.54±3.14)s,and enhancement time(16.44±4.12)s,(12.27±5.6)s,(7.09±1.64)s respectively,significant differences were shown between peak intensity time,enhancement time and tumor differentiation(P＜0.05).But there was no statistical significance in enhancement beginning time with different histopathologic grading.ConclusionsThe enhancement pattern of HCC was differentiated as "fast-in and fast-out" and "fast-in and slow-out",In the arterial phase,HCC has a typical enhancement consisting in a diffuse and rapid enhancement。Most HCCs were described as obviously hypoechoic and the others were isoechoic or appreciably hypoechoic in the late phase。There is relationship between the peak intensity time,enhancement time of HCCs and tumor differentiation.Those lesions which were enhanced quickly may be poor differentiated.CEUS maybe prompting the differentiation of tumors.