应用术中剪切波弹性成像和数字显微镜辅助形态计量学分析肝细胞癌患者肝组织剪切波弹性与组织病理学发现的关系。

Relationship between the liver tissue shear modulus and histopathologic findings analyzed by intraoperative shear wave elastography and digital microscopically assisted morphometry in patients with hepatocellular carcinoma.

机构信息

Department of Gastro enterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.

出版信息

J Ultrasound Med. 2014 Jan;33(1):61-71. doi: 10.7863/ultra.33.1.61.

DOI:10.7863/ultra.33.1.61

PMID:24371100

Abstract

OBJECTIVES

Shear wave elastography is a novel noninvasive method for assessing liver fibrosis by measuring liver stiffness. This study was conducted to evaluate how pathologic changes could have an impact on measured elasticity values in both resected hepatocellular carcinomas and adjacent liver tissue.

METHODS

Intraoperative shear wave elastography was performed in 7 patients who underwent liver resection at our institution; 7 hepatocellular carcinomas and adjacent liver tissue were subjected to elastographic measurements. A total of 48 circular regions of interest (ROIs; 3-8 mm in diameter) were located in the hepatocellular carcinomas (n = 37) and adjacent liver tissue (n = 11), and mean stiffness values were obtained from each ROI. All of the histologic images corresponding to the 48 ROIs after surgery were transformed into digital microscopic images by a scanning system, and histologic parameters, such as the proportions of nuclear areas, fatty areas, fibrous areas, and vessel areas, were quantitatively assessed. Relationships between the mean stiffness and the histologic parameters were investigated by the mixed effects model.

RESULTS

By univariate analysis, the proportions of collagen fiber areas (P = .039), fibrous areas (P = .045), hepatocellular nuclear areas (P = .045), and nuclear areas other than hepatocellular and lymphoplasmacytic areas (P = .039) showed statistically positive associations with mean stiffness values. Multivariate analysis indicated that the proportion of collagen fiber areas was the strongest pathologic determinant of mean stiffness (P = .008), with hepatocellular nuclear areas also having a significant effect (P = .010).

CONCLUSIONS

Fibrosis predictably affects elastographic estimation, but hepatocellular density (ie, hepatocellular nuclear areas) also alters elastographic assessment.

摘要

目的

剪切波弹性成像是一种通过测量肝脏硬度来评估肝纤维化的新型无创方法。本研究旨在评估在切除的肝细胞癌及其相邻肝组织中，病理变化如何影响测量的弹性值。

方法

在我院行肝切除术的 7 例患者中进行术中剪切波弹性成像；对 7 个肝细胞癌及其相邻肝组织进行弹性测量。在肝细胞癌（n = 37）和相邻肝组织（n = 11）中，共定位了 48 个圆形感兴趣区（ROI；直径 3-8mm），并从每个 ROI 获得平均硬度值。术后所有对应 48 个 ROI 的组织学图像通过扫描系统转化为数字显微镜图像，并定量评估核区、脂肪区、纤维区和血管区等组织学参数的比例。通过混合效应模型研究平均硬度与组织学参数之间的关系。

结果

单因素分析显示，胶原纤维面积比例（P =.039）、纤维面积比例（P =.045）、肝细胞核面积比例（P =.045）和非肝细胞和淋巴浆细胞核面积比例（P =.039）与平均硬度值呈正相关。多因素分析表明，胶原纤维面积比例是平均硬度的最强病理决定因素（P =.008），肝细胞核面积也有显著影响（P =.010）。