New malignant grading system for hepatocellular carcinoma using the Sonazoid contrast agent for ultrasonography
New malignant grading system for hepatocellular carcinoma using the Sonazoid contrast agent for ultrasonography
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DOI：
10.1007/s00535-013-0830-1
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发表时间：
2014-04-01
影响因子：
6.3
通讯作者：
Nishiguchi, Shuhei
中科院分区：
文献类型：
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作者：
Tanaka, Hironori;Iijima, Hiroko;Nishiguchi, Shuhei
超声造影剂 Sonazoid 根据其在库普弗细胞中的积累提供实质特异性对比成像（库普弗成像）。该试剂还有助于通过最大强度投影 (MIP) 对肿瘤中的精细血管结构进行成像。我们结合 2 种不同的对比增强超声图像检查了肝细胞癌 (HCC) 恶性肿瘤分级系统的临床实用性。我们研究了 121 例组织学确诊的 HCC 病例（高分化，45 例；中分化，70 例；低分化，6 例）。 Kupffer 成像的结果分为（1）等回声模式或（2）低回声模式。产生的MIP图案被分为以下类别之一：精细的肿瘤血管没有清晰地可视化和仅精细的血管可视化；血管、肿瘤血管清晰可见；不规则，肿瘤血管粗大且不规则。根据Kupffer成像和MIP模式的综合评估，将样本分为4级：1级（等细/血管）、2级（低细）、3级（低血管）和4级（低不规则）。中分化和低分化HCC的分布如下：1级，4%（1/24）； 2 级，52% (15/29)；三级，85% (44/52)；四年级，100% (16/16)。该分级系统还预测了 72 个切除的 HCC 中的门静脉侵犯：1 级，0 % (0/4)； 2 级，13%（1/8）；三级，23% (11/48)； 4 级，67 % (8/12)。这种新的恶性分级系统可用于估计 HCC 的组织学分化和门静脉侵犯。
The ultrasonography contrast agent Sonazoid provides parenchyma-specific contrast imaging (Kupffer imaging) based on its accumulation in Kupffer cells. This agent also facilitates imaging of the fine vascular architecture in tumors through maximum intensity projection (MIP). We examined the clinical utility of the malignancy grading system for hepatocellular carcinoma (HCC) using a combination of 2 different contrast-enhanced ultrasonography images.We studied 121 histologically confirmed cases of HCC (well-differentiated, 45; moderately differentiated, 70; poorly differentiated, 6). The results of Kupffer imaging were classified as (1) iso-echoic pattern or (2) hypo-echoic pattern. The MIP patterns produced were classified into one of the following categories: fine, tumor vessels were not clearly visualized and only fine vessels were visualized; vascular, tumor vessels were visualized clearly; irregular, tumor vessels were thick and irregular. Based on the combined assessment of Kupffer imaging and the MIP pattern, the samples were classified into 4 grades: Grade 1 (iso-fine/vascular), Grade 2 (hypo-fine), Grade 3 (hypo-vascular), and Grade 4 (hypo-irregular).The distribution of moderately and poorly differentiated HCCs was as follows: Grade 1, 4 % (1/24); Grade 2, 52 % (15/29); Grade 3, 85 % (44/52); and Grade 4, 100 % (16/16). The grading system also predicted portal vein invasion in 72 resected HCCs: Grade 1, 0 % (0/4); Grade 2, 13 % (1/8); Grade 3, 23 % (11/48); and Grade 4, 67 % (8/12).This new malignant grading system is useful for estimation of histological differentiation and portal vein invasion of HCC.