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

Objective:To evaluate the relationship between enhancement patterns of hepatocellular carcinoma(HCC) and tumor differentiation with contrast-enhanced ultrasound(CEUS) and explore the significant parameters between different differentiated HCC.Methods:This study included 53 patients from 2006.4 to 2009.3.There were 48 men and 5 women with hepatocellular carcinoma(age range,18～70years;mean age, 49±13years).The diameters of all the lesions range from70×21mm to 15×13mm.All the HCC lesions underwent examinations of CEUS,and autotraking contrast quantification(ACQ) was used to analyze the arrive time(AT),time to peak(TTP), peak intensity(PI),get the contrast-enhanced time,wash out time,enhancment slope,clearance slope of the lesions.All of the lesions were confirmed by operations.Each histopathological diagnosis was performed by a pathologist,and all the HCC lesions were divided into two groups according to the WHO grading system,and then run statistics analysis between them.Result:All the cases were separated into 2 groups:well differentiated HCC and moderate to poor differentiated HCC.9 of 14 well-differentiated HCCs appeared enhancement pattern as"fast-in and slow-out",5 of 14 well-differentiated HCCs appeared as "fast-in and fast-out";30 of 31 moderate to poor differentiated HCCs appeared as "fast-in and fast-out",1 of 31 moderate to poor differentiated HCCs appeared as "fast-in and slow-out"The data of the well differentiated HCCs:the microbubble arrive time(AT) is 7.76±3.47s,time to peak(TTP) is 25.73±4.04s,peak intensity(PI) is 29.14±3.67dB, contrast-enhanced time is 17.10±4.94s,wash out time is 46.34±11.48s,the enhancement slope is 1.73±0.54,clearance slope is 1.27±0.81.The data of moderate to poor differentiated HCCs:the microbubble arrive time(AT) is 3.97±3.87s,time to peak(TTP) is 16.78±7.57s,peak intensity(PI) is 27.03±3.84dB, contrast-enhanced time is 11.43±2.09s,wash out time is16.64±2.04s,enhancement slope is 2.70±1.14,clearance slope is 1.87±0.41.The statistical results between well differentiated HCC and moderate to poor differentiated HCC lesions are as follows:AT(t=2.10,p=0.052) and PI(t=1.16, p=0.26) show no significant statistics difference,while TTP(t=2.86,p=0.01), congtrast-enhanced time(t=3.40,p=0.004),wash out time(t=8.02,p=0.000), enhancement slope(t=2.48,p=0.02) and clearance slope(t=2.286,p=0.034) are of statistics significant.Conclusion:well differentiated HCC and moderate to poor differentiated HCC performance different on CEUS,the TTP,contrast-enhanced time,wash out time, enhancement slope and clearance slope between the two groups are of statistics significant,thus CEUS offers an effective way to judge the pathologic grading of HCC.