原发性肝细胞癌动态增强MR门脉期环形强化机制

Mechanism of surrounding rim enhancement on hepatocellular carcinoma in portal phase of enhanced dynamic MRI

目的探讨原发性肝细胞癌(HCC)于三维动态增强MR门脉期环形强化的机制。方法采用Propeller肝脏加速容积采集序列(LAVA)对HCC患者行多期动态增强扫描,观察门脉期病灶周边环形强化的状况及动脉期病灶有无动脉供血。对大体标本的病灶中心层面取中心组织2块及边缘组织4块,行常规HE染色,判定病灶有无包膜及病理分级。结果本组共38个HCC病灶,32个病灶门脉期表现为边缘环形强化,28个病灶动脉期表现有动脉供血;病理切片观察发现34个病灶可见包膜存在。统计结果表明:①HCC门脉期环形强化与包膜存在密切相关性(P<0.05);②HCC门脉期环形强化与动脉供血的相关性无统计学意义(P>0.05);③HCC门脉期环形强化与病变分化程度无明显相关性(P>0.05)。结论①三维动态增强MR门脉期的病灶周边环形强化是HCC的特征性表现之一;②三维动态增强MR门脉期肿瘤周边环形强化的形成与病灶周边包膜的存在密切相关,同时还可能与病灶的动脉供血密切相关。

Objective To investigate the mechanisms of surrounding rim enhancement of hepatocellular carcinoma in portal phase with 3D enhanced dynamic MRI. Methods The patients with hepatocellular carcinoma undertook Propeller liver acceleration volume acquisition （LAVA） sequence. The rim enhancement in portal phase and arterial blood-supply in arterial phase were estimated. The tissues were aquired in margin and center of lesion, and the capsule and pathologic grade of the lesion were evaluated. Results A total of 38 lesions were enrolled in study, 32 lesions appeared surrounding rim enhancement in portal phase; twenty-eight lesions showed arterial blood supply in arterial phase, and capsules or pseudo-capsules were found in 34 lesions. Statistical results indicated： （1）There was a significant relationship between rim enhancement in portal phase and the capsule （P〈0.05）. （2）No significant difference was found between rim enhancement in portal phase and arterial blood-supply in portal phase （P〉0. 05）. （3）There was no significant correlation between rim enhancement in portal phase and pathology grade of HCC. Conclusion （1）The surrounding rim enhancement in portal phase is distinctive feature of HCC on 3D enhanced dynamic MRI. （2）The surrounding rim enhancement is closely related to the existence of capsule or pseudo-capsule. And it may be related to arterial blood-supply.