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(Department of Medical Ultrasound, the First Affiliated Hospital, Sun Yat-sen University,Institute of Diagnostic and Interventional Ultrasound, Guangzhou 510080, China)

CEUS features of hepatitis B virus-related combined hepatocellular-cholangiocarcinoma and hepatocellular carcinoma： Comparative study

HUANGGuangliang,YEJieyi,ZHANGXiaoer,WANGWei,HUANGXiaowen,LYUMingde,XIEXiaoyan*

(DepartmentofMedicalUltrasound,theFirstAffiliatedHospital,SunYat-senUniversity,InstituteofDiagnosticandInterventionalUltrasound,Guangzhou510080,China)

Objective To comparatively analyze CEUS features of hepatitis B virus (HBV)-related combined hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC). Methods Thirty-one patients with HBV-related CHC and 31 patients with HBV-related HCC confirmed by pathology were enrolled and CEUS features were compared. Results On CEUS, HBV-related CHC and HBV-related HCC mainly manifested as hyper-enhanced in arterial phase and hypo-enhanced in portal phase and delayed phase. No significant differences of enhancement level on CEUS were found between HBV-related CHC and HBV-related HCC. When the maximum diameter of tumor ≤3.0 cm, both HBV-related CHC and HBV-related HCC were mainly homogeneous enhancement (P=1.000). When the maximum diameter of tumor more than 3.0 cm, diffuse heterogeneous enhancement and peripheral irregular rim-like enhancement were more commonly observed in HBV-related CHC, while diffuse heterogeneous enhancement was more commonly noted in HBV-related HCC (P=0.001). Conclusion The enhancement pattern of HBV-related CHC >3.0 cm has relative specific performance.

Liver neoplasms; Ultrasonography; Hepatitis B virus

混合型肝癌(combined hepatocellular-cholangiocarcinoma， CHC)是原发性肝癌的一种少见类型[1-2]，易发生门静脉侵犯及淋巴结转移[3]，术前正确诊断CHC对选择治疗方案有重要意义[4]。目前，CEUS已广泛应用于肝脏局灶性病变的诊断[5]，但关于CHC CEUS表现的研究[6]鲜见。由于临床对该病认识不足，加上乙型肝炎病毒感染是肝细胞癌(hepatocellular carcinoma， HCC)的主要病因，故多数乙型肝炎相关性CHC术前被误诊为HCC[7-9]。本研究旨在比较乙型肝炎相关性CHC与HCC的CEUS表现，以提高术前诊断水平。

1 资料与方法

1.1 一般资料 收集2005年6月—2015年12月在我院经病理证实的乙型肝炎相关性CHC患者31例，其中男26例、女5例，年龄18～69岁，平均(51.0±10.6)岁。29例经手术病理证实，2例经活检病理证实。另随机选取同期经病理证实的乙型肝炎相关性HCC患者31例，男30例，女1例，年龄39～78岁，平均(50.3±13.8)岁。患者的一般资料见表1。

1.2仪器与方法 采用Toshiba Aplio XV超声诊断仪，配备PVT-375BT探头，频率1.9～6.0 MHz，内置造影特定成像技术——对比谐波成像(contrast harmonic imaging, CHI)，机械指数0.05～0.08；采用Siemens Acuson Sequoia 512超声诊断仪，配备4 V1探头，频率1.0～4.0 MHz，内置造影特定成像技术——对比脉冲序列(contrast pulse sequencing， CPS)，机械指数0.15～0.21。造影剂采用声诺维，经肘前静脉团注2.4 ml，之后以5 ml生理盐水冲管。检查时先常规扫查肝脏和病灶再行CEUS，连续观察病灶5 min。

1.3图像分析 由2名高年资超声医师共同分析图像，常规超声主要观察病灶形态、大小、数目、回声、边界，有无肝内胆管扩张，有无血管癌栓及肿大淋巴结等。注射造影剂后观察动脉期(8～30 s)、门静脉期(31～120 s)、延迟期(121～300 s)，分析病变增强水平和增强模式。多发病灶选择最大病灶进行分析。

1.4统计学分析 采用SPSS 16.0统计分析软件。计量资料以±s表示，组间比较采用两独立样本t检验，计数资料组间比较采用χ2检验或Fisher精确概率法。P……