Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver.The incidence and mortality rates were ranked the sixth and three respectively in all kinds of tumors.Liver resection and liver transplantation has achieved remarkable curative effect in the treatment of early of HCC,but the recurrence is still an important problem to be solved.In HCC patients,local resection and liver transplantation after 5 years,the recurrence rate wasere 70％ and 35％,respectively.The invasiveness of tumor is different,and the recurrence rate is also different.Microvascular invasion (MVI) as a marker of tumor invasion has been widely used in the diagnosis of HCC.Some scholars believe that MVI imay bes the first step in the liver or systemic metastasis of liver cancer,if we can predicted the MVI before surgery,it will play a positive role in making treatment programs,because in order to reduce the recurrence rate,anatomic resection of and extended resection range is recommended.Advances in magic radiological technology have made made it possible to diagnose MVI before surgery.In this paper,CT,MRI,PET and ultrasound in the diagnosis of MVI would be introduced.

Objective To investigate the value of CEUS quantitative analysis in diagnosis of different pathological stages of small hepatocellular carcinoma (HCC).Methods Data of 112 patients with HCC confirmed by surgical or biopsy were analyzed retrospectively.All the diameter of single tumor or the sum of the largest two lesions in multiple tumors were within 3 cm.Three groups were classified based on the Edmonson stage:High differentiation group (n=50,stage Ⅰ or Ⅱ),median differentiation group (n=30,stage Ⅲ),low differentiation group (n=32,stage Ⅳ).Qontraxt ultrasound imaging analysis software was utilized to measure CEUS parameters,including the maximum intensity of tumor (TMAX),nontumor's intensity (NT),maximum intensity of nontumor (NTMAX),appear time,time to peak,washout time,and the ratio of TMAX/NT and TMAX/NTMAX were calculated.The differences among the three groups was compared by statistics test.Results The values of TMAX,TMAX/NTMAX and washout time were statistically different among the three groups (all P＜0.05).The maximum values of TMAX,TMAX/NTMAX and the shortest washout time were found in the low differentiation group.And the minimum values of TMAX,TMAX/NTMAX and the longest washout time were found in the high differentiation group.There were no statistical differences of NT,NTMAX,TMAX/NT,appear time and time to peak among the three groups (all P＞0.05).Conclusion The quantitative parameters of CEUS is helpful in distinguishing different Edmonson stage of small HCC.

BACKGROUND: Body mass index(BMI)is a commonly used phenotype for obesity,which is determined by multiple genetic factors.OBJECTIVE: To investigate whether osteocalcin(also known as bone Gla protein,BGP)Hind Ⅲ genetic polymorphism is associated with BMI variation.METHODS: A total of 390 premenopausal women from a local population of Nanchang City were selected.Body weight and height were measured.All participants were genotyped at the BGP Hind Ⅲ locus using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP).RESULTS AND CONCLUSION: The BGP genotype frequencies of HH,Hh and hh were 0.077,0.408 and 0.515,respectively.The distribution of BGP Hind Ⅲ genotypes was consistent with Hardy-Weinberg equilibrium(P > 0.05).The BGP Hind Ⅲ were significantly associated with BMI(P=0.002),which could explain about 5.47% of BMI variation.On average,BMI of individuals with HH genotype was the highest[(22.81±0.73)kg/m2],individuals with Hh genotype was intermediate[(21.50±0.53)kg/m2],while individuals with hh genotype was the lowest[(20.23±0.63)kg/m2].Therefore,carriers of HH and Hh genotypes had,respectively,approximately 12.75% and 6.28% higher BMI than carriers of the hh genotype.To our best knowledge,this is the first study reporting the association of BGP Hind Ⅲ genetic polymorphism and BMI in healthy premenopausal women.

Objective To investigate the correlation and predictive value between contrast-enhanced ultrasonography (CEUS) and microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).Methods Total of 233 (162 male,71 female) patients treated from July 2013 to September 2016 at the Mengchao Hepatobiliary Hospital of Fujian Medical University were enrolled in this research.The mean age ± SD was 55.1 ± 11.6 years.MVI was positive in 85 patients and negative in 148 patients.All patients underwent CEUS examination within one week before operation.A quantitative analysis software was used to analyze the size,shape and volume of the tumors.The difference in the volume of the tumors before and after CEUS,the peak intensity of the tumors and the washout time of the tumors were recorded.This study aimed to analyze the influencing factors of MVI in HCC patients,and the predictive value of MVI.Results Compared with the MVI negative group,the MVI positive group had larger tumor diameters,higher proportions of middle/low differentiation,irregular shapes and rapid clearance,shorter clearance time and a larger difference in tumor volume before and after angiography (P＜0.05).Multivariate logistic regression analysis after excluding collinearity showed that a large diameter of tumors,large difference in tumor volume before and after CEUS,and faster washout were influencing factors of MVI in HCC patients.The ROC curve was used to analyze the predictive value of tumor volume difference on MVI before and after angiography.The cut-off value was 2.195.The sensitivity,specificity,positive predictive value and negative predictive value were 0.682,0.696,67.9％ and 72.8％,respectively.Conclusion Large diameter of tumors,large difference in volume of tumors before and after CEUS,and fast washout time were influencing factors of MVI in HCC patients.A quantitative analysis of CEUS could predict the presence of MVI.

Objective To evaluate the value of shear wave elastography(SWE) in the diagnosis of gastroesophageal varices in patients with hepatitis B-related hepatocellular carcinoma(HCC). Methods From October 2016 to May 2017,a total of 325 patients with hepatitis B-related HCC received conventional ultrasonography and SWE examinations in Shanghai Eastern Hepatobiliary Surgery Hospital were selected. The basic clinical data,conventional ultrasonography,SWE examination parameters and gastroscopy results of 192 patients were successfully collected. The training group ( 120 cases) and the validation group (72 cases) were divided from these patients according to the time order of entering the study.The gastroscopy results were used as the gold standard and the training group were analyzed using univariate and multivariate analysis.A new GOV diagnostic model was established and the diagnosis value of which were validated and evaluated in the validation group. Results Among 9 parameters studied,the maximum flow velocity of the portal vein,the thickness of the spleen and the stiffness of the spleen were independent factors affecting GOV in patients with hepatitis B-related HCC with odds ratio of 0.755(95% CI 0.617-0.924),1.375(95%CI 1.171-1.614) and 1.093(95% CI 1.043 -1.145),respectively(all P < 0.01).T he area under ROC curve of GOV diagnostic model that containd these 3 parameters diagnosing GOV in validation group was 0.914 (95% CI,0.832~0.995).The -1.49 was the best cut-off value with sensitivity,specificity,positive predictive value,negative predivtive value and coincidence rate of 79.0%,92.5%,91.3%,81.5% and 85.8%,respectively. Conclusions The GOV diagnostic model established by combining SWE and conventional ultrasonography is of certain value in diagnosis of GOV in patients with hepatitis B-related HCC yet needs further validation.

Objective:To study the predictive value of combining ultrasound elestography with serological examination on incidences of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).Methods:The clinical data of 288 patients with HCC who underwent liver resection at MengChao Hepatobiliary Hospital of Fujian Medical University from January 2018 to September 2020 were retrospectively analyzed. 104 MVI-negative and 184 MVI-positive patients who were confirmed by postoperative histopathology were divided into the MVI-negative and MVI-positive groups respectively. Serological indicators of alanine aminotransferase, aspartate aminotransferase, platelet, albumin, and alpha-fetoprotein were compared between groups. Imaging indexes including elasticity at liver tumor surrounding 1 cm area (S1), elasticity at liver tumor surrounding 2 cm area (S2), S1S2index (S1/S2×10) and longest tumor diameter were compared between groups. Multi-variate analysis was used to screen out independent risk factors in predicting MVI of hepatocellular carcinoma, and then a nomogram model was constructed.Results:Of 288 patients with HCC who met the inclusion criteria of this study, there were 225 males and 63 females, aged (56.3±9.7) years. Multivariate logistic regression analysis revealed that patients with HCC who had multiple tumors ( OR=2.47, 95% CI: 1.41-4.33, P=0.002), long tumor diameter ( OR=1.21, 95% CI: 1.08-1.36, P=0.031), AFP>400 μg/L ( OR=2.83, 95% CI: 1.54-5.22, P=0.015), a high S1S2index ( OR=1.33, 95% CI: 1.17-1.51, P=0.025) had high incidences of MVI. The nomogram model constructed from these risk factors showed the risk of MVI in HCC patients with a mean absolute deviation of compliance between the predicted value and the true value being 0.021. The receiver operating characteristic (ROC) curve showed that the area under ROC curve of the nomogram model which predicted MVI of HCC patients was 0.777 (95% CI: 0.720-0.835). Conclusions:Multiple tumors, long tumor diameter, AFP>400 μg/L and a high S1S2 index were independent risk factors for MVI in HCC patients. The nomogram model established by these factors accurately predicted the risk of MVI and provided a reference for better choice of treatment.