钆塞酸增强 MRI 肝胆期肝癌周边高信号：与周边增生及其病理特征的相关性。
Peri-tumoral hyperintensity on hepatobiliary phase of gadoxetic acid-enhanced MRI in hepatocellular carcinomas: correlation with peri-tumoral hyperplasia and its pathological features.
机构信息
Department of Radiology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan.
Division of Pathology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan.
出版信息
Abdom Radiol (NY). 2018 Aug;43(8):2103-2112. doi: 10.1007/s00261-017-1437-4.
PURPOSE
Peri-tumoral hyperintensity (P-hyperintensity) is occasionally seen in hepatocellular carcinoma (HCC) on the hepatobiliary (HB) phase of gadoxetic acid-enhanced MRI (EOB-MRI). A recent study reported peri-tumoral hyperplasia (P-hyperplasia) associated with over-expression of glutamine synthetase (GS) in HCC or metastatic carcinoma. The aim of this study was to analyze the correlation between P-hyperintensity on the HB phase and GS expression indicating P-hyperplasia and reveal its pathological features.
METHODS
Seventy-seven surgically resected HCCs from 68 patients were analyzed. The grade of P-hyperintensity on HB phase was divided according to the degree of the peri-tumoral hyperintense signal: grade 0 (no P-hyperintensity), grade 1 (less than 50% of the tumor border), grade 2 (50%-80%), grade 3 (80%-100%). Immunohistochemical staining for GS and organic anion transporter polypeptides (OATP)1B3 was performed. The relationships among P-hyperplasia (peri-tumoral GS expression) and OATP1B3 expression, P-hyperintensity, and pathological features of the tumor were analyzed.
RESULTS
Thirty-four HCCs were classified as P-hyperintensity grade 0, 29 HCCs as grade 1,10 nodules as grade 2, and 4 HCCs as grade 3. P-hyperplasia was observed in 3/34 (8.8%) P-hyperintensity grade 0, 16/29 (55.2%) grade 1, 9/10 (90%) grade 2, and 4/4 (100%) grade 3. The incidence of P-hyperplasia was significantly increased in P-hyperintensity grades 1-3 compared with grade 0 (p < 0.0001). Hepatocytes in all P-hyperplasia sites demonstrated definite OATP1B3 expression. Microscopic hepatic venous invasion was significantly increased in P-hyperintensity-positive HCCs compared with negative HCCs (p = 0.0017).
CONCLUSIONS
P-hyperintensity on HB phase in HCC may indicate p-hyperplasia with GS and OATP1B3 expression and a higher incidence of microscopic hepatic venous invasion.
目的
在钆塞酸增强磁共振成像（EOB-MRI）肝胆期，偶尔会在肝细胞癌（HCC）中观察到肿瘤周围高信号（P-hyperintensity）。最近的一项研究报道了与谷氨酰胺合成酶（GS）过表达相关的肿瘤周围增生（P-hyperplasia）在 HCC 或转移性癌中。本研究旨在分析肝胆期 P-hyperintensity 与提示 P-hyperplasia 的 GS 表达之间的相关性，并揭示其病理特征。
方法
分析了 68 例患者的 77 例手术切除 HCC。根据肿瘤周围高信号的程度将肝胆期 P-hyperintensity 分级：0 级（无 P-hyperintensity）、1 级（肿瘤边界<50%）、2 级（50%-80%）、3 级（80%-100%）。进行 GS 和有机阴离子转运多肽 1B3（OATP1B3）的免疫组织化学染色。分析 P-hyperplasia（肿瘤周围 GS 表达）与 OATP1B3 表达、P-hyperintensity 以及肿瘤的病理特征之间的关系。
结果
34 例 HCC 被归类为 P-hyperintensity 0 级，29 例 HCC 为 1 级，10 个结节为 2 级，4 个 HCC 为 3 级。在 P-hyperintensity 0 级的 34 例中观察到 P-hyperplasia 3 例（8.8%），在 P-hyperintensity 1 级的 29 例中观察到 16 例（55.2%），在 P-hyperintensity 2 级的 10 例中观察到 9 例（90%），在 P-hyperintensity 3 级的 4 例中观察到 4 例（100%）。与 P-hyperintensity 0 级相比，P-hyperintensity 1-3 级的 P-hyperplasia 发生率显著增加（p<0.0001）。所有 P-hyperplasia 部位的肝细胞均表现出明确的 OATP1B3 表达。与 P-hyperintensity 阴性 HCC 相比，P-hyperintensity 阳性 HCC 中微小肝静脉侵犯的发生率显著增加（p=0.0017）。
结论
HCC 肝胆期的 P-hyperintensity 可能提示存在 P-hyperplasia，伴有 GS 和 OATP1B3 表达，并伴有更高的微小肝静脉侵犯发生率。
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