论文部分内容阅读
目的 探讨肝细胞癌 (hepatocellularcarcinoma ,HCC)动态增强表现的病理基础。资料与方法 分析 35例经手术病理证实的HCC动态增强MRI征象及病理表现。图像分析包括HCC动脉期、门脉期双期强化表现 ,动脉期强化程度。病理分析包括癌细胞分化程度、癌组织结构类型。结果 根据动脉期、门脉期信号强度及其演变分为Ⅰ、Ⅱ、Ⅲ型动态强化类型。Ⅰ型为动脉期强化高于或等于肝实质 ,门脉期低于肝实质 ;Ⅱ型为动脉期、门脉期强化均高于或等于肝实质 ;Ⅲ型为动脉期、门脉期强化均低于肝实质。 35例中Ⅰ型强化 1 9例 ,Ⅱ型 1 2例 ,Ⅲ型 4例。Ⅰ型强化中分化差的HCC比率显著高于其他类型 (精确检验 ,P =0 .0 0 7) ,Ⅱ型强化中分化好的HCC比率显著高于其他类型 (精确检验 ,P =0 .0 1 1 )。实体型与硬化型主要表现Ⅰ型强化 ,梁索型及假腺管型Ⅰ型和Ⅱ型强化均较多见。动脉期不同强化程度HCC其癌细胞分化无显著性差异 ,但明显强化的HCC以分化差多见。结论 MR动态增强类型可反映HCC的分化程度 ,并在一定程度上可反映出HCC的血供 ,可为HCC外科手术和介入治疗提供无创的影像学依据 ,并有助于判断预后
Objective To investigate the pathological basis of dynamic enhancement of hepatocellular carcinoma (HCC). Materials and Methods 35 cases of pathologically confirmed HCC dynamic enhanced MRI signs and pathological findings. Image analysis included HCC arterial phase, portal phase double enhancement, and arterial phase enhancement. Pathological analysis includes the degree of differentiation of cancer cells and the type of cancer tissue. The results according to the arterial phase, portal phase signal intensity and its evolution into Ⅰ, Ⅱ, Ⅲ type of dynamic strengthening. Type I was higher than or equal to the parenchyma in the arterial phase, and portal phase was lower than that in the liver parenchyma. Type II was in the arterial phase with enhanced portal phase higher than or equal to the liver parenchyma. Type III was in the arterial phase and portal phase enhanced Lower than the liver parenchyma. Among the 35 cases, type Ⅰ enhanced in 19 cases, type Ⅱ 12 cases, type Ⅲ in 4 cases. The percentage of poorly differentiated HCCs in type I enhancement was significantly higher than in other types (exact test, P = 0.07), and the rate of well differentiated HCCs in type II enhancement was significantly higher than in other types (exact test, P = 0 .0 1 1). Physical and hardening of the main performance Ⅰ-type reinforcement, beam type and pseudotubular type Ⅰ and Ⅱ-type enhancement are more common. There was no significant difference in differentiation of HCC cells between HCCs with different degree of enhancement in arterial phase, but HCC with marked enhancement was more common in poorly differentiated HCC. Conclusions The types of MR dynamic enhancement can reflect the degree of HCC differentiation and to a certain extent reflect the blood supply of HCC, which can provide noninvasive imaging basis for HCC surgery and interventional therapy and help to judge the prognosis