论文部分内容阅读
目的探讨肝细胞癌肿瘤血管生成及其成熟度对动态增强MR参数的影响。资料与方法选取行手术切除并经病理证实的肝细胞癌患者资料31例,术前行MR动态增强扫描,然后分析测量病灶的动态增强曲线类型、最大上升斜率(MSI)、信号增强率(SER)、正性增强积分(PEI)、最大下降斜率(MSD)和峰值(PV)。手术后在与MR测量相同位置取材,利用免疫组织化学技术检测VEGF、Flk-1、PCNA的表达情况,并对微血管和成熟血管的数目、平均面积、总面积、周长、直径、异型指数、血管间距、表达部位以及动脉数、静脉数、动脉比、静脉比、血管成熟指数和平均灌注分数等进行计数。将动态MR技术测得的各个参数与以上血管数据进行对照分析。结果在病灶边缘与中心,微血管的数目、直径及异型指数、成熟血管的数目和总面积、动脉数、动脉比、静脉比、血管成熟指数及平均灌注分数均存在明显差异(P<0.05);MR动态强化曲线类型及MSI、SER、PEI、MSD和PV各值差异也具有统计学意义(P<0.05)。静脉数和微血管异型指数影响强化曲线类型。在病灶边缘,SER分别与微血管总面积及周长、MSI与成熟血管数及静脉数、MSD与成熟血管异型指数、PV与成熟血管数均具有相关性;而在病灶中心,SER分别与微血管平均面积、成熟血管总面积及血管成熟指数、MSI与血管成熟指数和成熟血管异型指数、MSD与微血管周长及成熟血管总面积、PV与成熟血管周长及成熟血管异型指数也显示出相关性(P<0.05)。PEI与各血管参数之间无相关性(P>0.05)。结论肝细胞癌边缘和中心的动态增强特征不同,动态增强MR参数主要受成熟血管的影响,动态增强MR技术可用于评价肝细胞癌的成熟血管特征。
Objective To investigate the effect of tumor angiogenesis and maturation on dynamic enhancement of MR parameters in hepatocellular carcinoma. MATERIALS AND METHODS: Thirty-one patients with hepatocellular carcinoma (HCC) who underwent surgical resection and confirmed by pathology were enrolled in this study. MR dynamic contrast-enhanced scanning was performed preoperatively. The dynamic enhancement curve type, maximum rising slope (MSI), signal enhancement rate ), Positive enhancement integral (PEI), maximum descent slope (MSD) and peak (PV). After the operation, the samples were taken at the same position as the MR measurement. The expression of VEGF, Flk-1 and PCNA were detected by immunohistochemistry. The number of microvascular and mature blood vessels, the average area, the total area, the circumference, the diameter, the atypia index, Vascular distance, expression sites and the number of arteries, veins, artery ratio, venous ratio, vascular maturation index and the average perfusion score were counted. Various parameters measured by dynamic MR technique were compared with the above blood vessel data. Results There were significant differences (P <0.05) in the edge and center of the lesion, the number of microvessels, diameter and atypia index, the number and area of mature vessels, the number of arteries, arterial ratio, venous ratio, vascular maturation index and average perfusion score. The dynamic enhancement curves of MR and the differences of MSI, SER, PEI, MSD and PV were also statistically significant (P <0.05). The number of veins and microvascular atypia index affected the type of enhancement curve. At the margin of lesion, SER was correlated with the total area and circumference of microvessels, the number of MSI, the number of mature vessels and veins, the index of MSD and mature vessels, and the number of PV and mature vessel respectively. In the center of lesion, The area, the area of mature blood vessels and the index of vascular maturity, the index of MSI, mature index of blood vessel and mature atherosclerosis index, the total area of MSD, microvascular perimeter and mature blood vessel, PV and mature vascular perimeter and mature vascular atypia index also showed correlation P <0.05). There was no correlation between PEI and vascular parameters (P> 0.05). Conclusions The dynamic enhancement characteristics of the edge and center of hepatocellular carcinoma are different. The dynamic enhancement MR parameters are mainly affected by mature blood vessels. The dynamic enhancement MR technique can be used to evaluate the mature blood vessel characteristics of hepatocellular carcinoma.