关键词: 肝细胞肝癌, 超声造影, 病理学, 分化程度, 鉴别价值

Abstract:

Objective　To explore the value of contrast-enhanced ultrasound blood flow perfusion parameters in distinguishing the pathological differentiation degrees of hepatocellular carcinoma. Methods　A retrospective analysis was conducted on the clinical data of 134 patients with hepatocellular carcinoma treated in Ankang Traditional Chinese Medicine Hospital from May 2022 to March 2024. There were 96 males and 38 females who were (59.72±10.85) years old. All the patients underwent contrast-enhanced ultrasound examination before the treatment. The blood flow perfusion parameters (initial increase time, peak time, initial retreat time, peak enhancement time, clearance time, initial increase intensity, peak intensity, and average blood flow density) were recorded. The degree of tissue differentiation was determined based on the pathological examination results. The blood flow perfusion parameters of contrast-enhanced ultrasound in the patients with hepatocellular carcinoma of different differentiation degrees were compared, and the value of contrast-enhanced ultrasound blood flow perfusion parameters in distinguishing the pathological differentiation degrees of hepatocellular carcinoma was analyzed using receiver operating characteristic curves (ROC). The statistical methods included nonparametric rank sum test and one-way analysis of variance. Results　Among the 134 patients, 31 were highly differentiated, 59 were moderately differentiated, and 44 were poorly differentiated. There were no statistical differences in initial increase time, initial increase intensity, and peak intensity between the patients with hepatocellular carcinoma of different differentiation degrees (all P>0.05). There were statistical differences in the peak time [(38.29±8.19) s, (28.03±6.69) s, and (23.55±3.61) s], peak enhancement time [21.00 (19.50, 24.50) s, 14.00 (10.00, 18.50) s, and 10.50 (9.00, 12.25) s], initial retreat time [(131.97±37.10) s, (79.44±25.98) s, and (56.11±18.59) s], clearance time [(76.45±23.58) s, (47.90±14.91) s, and (33.05±10.32) s], and average blood flow density (0.36±0.10, 0.57±0.15, and 0.78±0.22) between the patients of high, moderate, and poor differentiation (all P<0.05). The peak time, peak enhancement time, initial retreat time, and clearance time decreased from the patients of high differentiation to the patients of moderate differentiation, and to the patients of poor differentiation, while the average blood flow density increased (P<0.05). The ROC analysis results showed that the areas under the curves for distinguishing the pathological differentiation degrees of hepatocellular carcinoma based on peak time, peak enhancement time, initial retreat time, clearance time, and average blood flow density were 0.767, 0.778, 0.830, 0.824, and 0.828, respectively. The area under the curve of the combined diagnosis of the five factors (0.920) was higher than that of the single diagnosis (all P<0.05). Conclusion　The peak time, peak enhancement time, initial retreat time, clearance time, and average blood flow density in contrast-enhanced ultrasound perfusion parameters can all be used to differentiate the pathological differentiation degrees of hepatocellular carcinoma, and the combined value of these five parameters is higher.

Key words: Hepatocellular carcinoma,  , Contrast-enhanced ultrasound,  , Pathology,  , Degree of differentiation,  , Identification value