肝细胞癌肿瘤边缘的计算机断层扫描灌注与组织病理学的相关性

A correlation of computed tomography perfusion and histopathology in tumor edges of hepatocellular carcinoma.

作者信息

Bai Rong-Jie, Li Jin-Ping, Ren Shao-Hua, Jiang Hui-Jie, Liu Xin-Ding, Ling Zai-Sheng, Huang Qi, Feng Guang-Long

机构信息

Department of Radiology, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2014 Dec;13(6):612-7. doi: 10.1016/s1499-3872(14)60298-8.

DOI:10.1016/s1499-3872(14)60298-8

PMID:25475863

Abstract

BACKGROUND

The peripheral morphologic characteristics of hepatocellular carcinoma (HCC) reflect tumor growth patterns. Computed tomography (CT) perfusion is a new method to analyze hemodynamic changes in tissues. We assessed the relationship between CT perfusion and histopathologic findings in the periphery of HCC lesions.

METHODS

Non-contrast CT, enhanced dual-phase CT, and CT perfusion were performed on 77 subjects (47 patients and 30 controls). Based on the imaging findings of enhanced dual-phase CT, the tumor edges were classified into three types: type I (sharp); type II (blurry); and type III (mixed). The CT perfusion parameters included hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion. The tissue sections from resected specimens were subjected to routine hematoxylin and eosin staining and immunohistochemical staining for CD34. The correlations between microvessel density (MVD) and the CT perfusion parameters were analyzed using Pearson's product-moment correlation coefficient. Changes in the perfusion parameters in tumor edges of different tumor types were evaluated.

RESULTS

Type I (sharp): the pathologic findings showed fibrous connective tissue capsules in the tumor edges, and an MVD ≤30/mm2. Type II (blurry): the histology showed that the edges were clear with no capsules and an MVD>30/mm2. Type III (mixed): the pathology was similar to that of types I and II, and an MVD>30/mm2. Hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion were significantly increased in the tumor edges of HCC patients compared to those of the controls (P<0.05). The correlation between CT perfusion parameters and MVD was higher in blurry tumor edges of type II than in those of types I or III.

CONCLUSION

CT perfusion imaging of tumor edges may be helpful in revealing histopathological features, and indirectly reflect angiogenic changes of HCCs.

摘要

背景

肝细胞癌（HCC）的外周形态学特征反映肿瘤生长模式。计算机断层扫描（CT）灌注是分析组织血流动力学变化的一种新方法。我们评估了HCC病变外周CT灌注与组织病理学结果之间的关系。

方法

对77名受试者（47例患者和30名对照）进行了平扫CT、增强双期CT及CT灌注检查。根据增强双期CT的影像学表现，将肿瘤边缘分为三种类型：I型（清晰）；II型（模糊）；III型（混合）。CT灌注参数包括肝血流量、肝动脉分数、肝动脉灌注及肝门静脉灌注。对切除标本的组织切片进行常规苏木精-伊红染色及CD34免疫组化染色。采用Pearson积矩相关系数分析微血管密度（MVD）与CT灌注参数之间的相关性。评估不同肿瘤类型肿瘤边缘灌注参数的变化。

结果

I型（清晰）：病理结果显示肿瘤边缘有纤维结缔组织包膜，MVD≤30/mm²。II型（模糊）：组织学显示边缘清晰，无包膜，MVD>30/mm²。III型（混合）：病理与I型和II型相似，MVD>30/mm²。与对照组相比，HCC患者肿瘤边缘的肝血流量、肝动脉分数、肝动脉灌注及肝门静脉灌注显著增加（P<0.05）。II型模糊肿瘤边缘的CT灌注参数与MVD之间的相关性高于I型或III型。