肝细胞癌CT灌注参数与微血管密度的相关性研究

The correlation between CT perfusion parameters and microvessel density in hepatocellular carcinoma

目的探讨肝细胞癌(HCC)的CT灌注参数与微血管密度(MVD)之间的相关性。方法以18例行CT灌注扫描检查并经病理及免疫组织化学染色证实的患者为研究对象。CT灌注扫描计算的血供参数包括肝动脉灌流量(HAP)、门静脉灌流量(PVP)、肝总灌流量(TLP)、肝动脉灌流指数(HAI)、门静脉灌流指数(PVI)。病理组织切片经HE及CD34染色,确定癌细胞分化程度及测定组织MVD。分析CT灌注参数与肿瘤恶性程度及MVD之间的相关性。结果18例中,高分化HCC5例,中分化HCC7例,低分化HCC6例。MVD分别为高分化组736个/mm2,中分化组1667个/mm2,低分化组2382个/mm2。各组灌注参数HAP、PVP、TLP、HAI、PVI分别依次为高分化组0478ml·min-1·ml-1、0441ml·min-1·ml-1、0918ml·min-1·ml-1、052、048;中分化组1216ml·min-1·ml-1、0587ml·min-1·ml-1、1803ml·min-1·ml-1、067、033;低分化组1103ml·min-1·ml-1、0473ml·min-1·ml-1、1576ml·min-1·ml-1、071、029。结果表明,高分化HCC的MVD、PVP、TLP、HAI最低,PVI最高(P值均<001);中分化HCC的PVP、TLP最高(P<001);低分化HCC的MVD、HAI最高,PVI最低(P<005)。结论CT灌流指数是反映肿瘤恶性程度及肿瘤血管生成的较好指标。

Objective To explore the correlation of CT perfusion data of hepatocellular carcinoma (HCC) with microvessel density (MVD). Methods Eighteen cases of HCC proved by pathology and examined by perfusion CT and CD34 staining were studied. After plain CT scan of the whole liver, a single slice near the center of the lesion and the porta hepatis was repeatedly scanned for 42 s or 41.25 s after intravenous bolus injection of 30~40 ml nonionic contrast media at 4.5~6.7 ml/s. Time-density curve (TDC) of aorta, hepatic artery, portal vein, liver, and spleen were analyzed. The perfusion data such as hepatic arterial perfusion (HAP), portal vein perfusion (PVP), total liver perfusion (TLP), hepatic arterial perfusion index (HAI), and portal vein perfusion index (PVI) were calculated. Pathologic grade and MVD was defined by routine HE and CD34 stain respectively. Results Of the 18 cases, 5 were well-differentiated HCC, 7 moderate, and 6 low. MVD of well-, mid-, and low-differentiated HCC was 73.6, 166.7, and 238.2 per mm2, respectively. The mean perfusion data in turn of HAP, PVP, TLP, HAI, and PVI of the three subgroup were 0.478 ml·min^-1 ·ml^-1 , 0.441 ml·min^-1 ·ml^-1 , 0.918 ml·min^-1 ·ml^-1 , 0.52, 0.48 and 1.216 ml·min^-1 ·ml^-1 , 0.587 ml·min^-1 ·ml^-1 , 1.803 ml·min^-1 ·ml^-1 , 0.67, 0.33 and 1.103 ml·min^-1 ·ml^-1 , 0.473 ml·min^-1 ·ml^-1 , 1.576 ml·min^-1 ·ml^-1 , 0.71, 0.29, respectively. The results showed that well-differentiated HCC had lowest MVD, HAP, PVP, TLP, HAI and highest PVI(P<0.01), and mid-differentiated HCC had highest PVP and TLP, while low-differentiated HCC had highest MVD and HAI and lowest PVI(P<0.05). Conclusion The perfusion data, especially the perfusion index correlate well with MVD and the pathologic grade of HCC, thus perfusion CT offers a new way to assess the MVD and the pathologic grade of HCC in vivo.