Long Xueying, Cao Jue, Shi Linbo, Li Wenzheng, Liu Hui
Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009 Nov;34(11):1096-102.
(1)To obtain the perfusion parameters of hepatocellular carcinomas(HCCs), peritumour livers and normal livers by multi-slice CT(MSCT)and to investigate their characteristics and clinical significances;(2)To investigate the correlation among perfusion parameters, survivin expression, microvessel density(MVD)and pathologic grade of HCCs.
A total of 31 patients with HCC (5 well-differentiated HCCs, 17 moderately differentiated HCCs, and 9 poorly differentiated HCCs) and 10 normal liver were studied. All underwent CT plain scan, perfusion scan, and conventional enhancement scan of the whole liver using 16-slice spiral CT (Philips Brilliance 16). Perfusion parameters were obtained by time-density curves (TDC) of region of interest (ROI) through the perfusion scans. Tissue sections of HCCs and their corresponding peritumour liver tissues of the 31 patients were detected by immunohistochemistry (SABC methods) for protein expression of survivin and MVD, and 10 normal liver tissue sections were as used as negative controls. The correlation among the perfusion parameters, survivin expression, MVD and pathology grade were analysed.
(1)The mean values of HAP, HPP, TLP, and HAI of HCCs were 27.50 mL/(min.100 mL), 19.37 mL/(min.100 mL), 46.87 mL/(min.100 mL), and 60.38%, respectively. The mean values of those of the peritumour livers were 14.93 mL/(min.100 mL), 55.70 mL/(min.100 mL), 69.63 mL/(min.100 mL), and 21.51%, respectively. The mean value of those of the normal livers were 12.22 mL/(min.100mL), 74.56 mL/(min.100 mL), 86.78 mL/(min.100 mL), and 14.00%, respectively. The values of HAP and HAI of HCCs were significantly higher than those of the peritumor livers and the normal livers(P<0.01), and the HPP and TLP of HCCs were significant lower than those of the normal livers(P<0.01).The increase of HAP and decrease of HPP of peritumor livers were both significant compared with that of the normal livers(P<0.05). The HAP, HPP, and HAI of HCCs were significantly different from those of peritumor livers (P<0.01)except TLP. (2) Survivin expression in HCCs was detected in 23/31(74.1%), which was significantly higher than that in corresponding non-cancerous adjacent liver tissues and normal liver tissues (P<0.01). Survivin expression was positively correlated with MVD in HCCs. (3) HAP values were significantly and positively correlated with survivin expression (r=0.932,P<0.01)in HCCs.(4)The values of HAP and HAI were correlated with the pathologic grade in HCCs, and those values were increased gradually(P<0.05) among well differentiated HCCs, moderately differentiated, and poorly differentiated HCCs.
CTPI can quantitatively reflect abnormal blood supply of HCCs, which will be helpful for the detection and differentiation of lesions. CT perfusion parameters well correlate with survivin expression, MVD, and the pathologic grade in HCCs, which illustrate that CTPI could hopefully be used to evaluate the angiogenesis and biological behaviors of HCCs prospectively, noninvasively, and dynamically.
（1）通过多层螺旋CT（MSCT）获取肝细胞癌（HCC）、癌周肝组织及正常肝组织的灌注参数，探讨其特点及临床意义；（2）研究HCC灌注参数、生存素表达、微血管密度（MVD）及病理分级之间的相关性。
对31例HCC患者（高分化HCC 5例，中分化HCC 17例，低分化HCC 9例）及10例正常肝脏进行研究。所有患者均采用16层螺旋CT（飞利浦Brilliance 16）行全肝CT平扫、灌注扫描及常规增强扫描。通过灌注扫描获得感兴趣区（ROI）的时间-密度曲线（TDC），进而得到灌注参数。采用免疫组织化学（SABC法）检测31例HCC患者及其相应癌周肝组织中生存素蛋白表达及MVD，10例正常肝组织切片作为阴性对照。分析灌注参数、生存素表达、MVD及病理分级之间的相关性。
（1）HCC的肝动脉灌注（HAP）、肝动脉灌注峰值（HPP）、总肝灌注量（TLP）及肝动脉灌注指数（HAI）均值分别为27.50 mL/（min·100 mL）、19.37 mL/（min·100 mL）、46.87 mL/（min·100 mL）及60.38%。癌周肝组织的上述参数均值分别为14.93 mL/（min·100 mL）、55.70 mL/（min·100 mL）、69.63 mL/（min·100 mL）及21.51%。正常肝脏的上述参数均值分别为12.22 mL/（min·100 mL）、74.56 mL/（min·100 mL）、86.78 mL/（min·100 mL）及14.00%。HCC的HAP及HAI值显著高于癌周肝组织及正常肝脏（P<0.01），HCC的HPP及TLP显著低于正常肝脏（P<0.01）。与正常肝脏相比，癌周肝组织的HAP升高及HPP降低均有统计学意义（P<0.05）。除TLP外，HCC的HAP、HPP及HAI与癌周肝组织均有显著差异（P<0.01）。（2）31例HCC中23例（74.1%）检测到生存素表达，显著高于相应癌旁肝组织及正常肝组织（P<0.01）。HCC中生存素表达与MVD呈正相关。（3）HCC中HAP值与生存素表达显著正相关（r=0.932，P<0.01）。（4）HCC中HAP及HAI值与病理分级相关，在高分化、中分化及低分化HCC中这些值逐渐升高（P<0.05）。
CT灌注成像（CTPI）能定量反映HCC的异常血供，有助于病变的检测与鉴别。CT灌注参数与HCC中生存素表达、MVD及病理分级密切相关，表明CTPI有望用于前瞻性、无创及动态评估HCC的血管生成及生物学行为。
