原发性肝细胞癌的CT动态增强表现与细胞DNA增殖水平的关系及其临床意义

Relationship between CT perfusion imaging characteristics and DNA proliferation in patients with hepatocellular carcinoma

目的探讨原发性肝细胞癌的CT动态增强表现与细胞DNA增殖水平的关系及其临床意义。方法原发性肝细胞癌(HCC)35例,根据CT动态增强表现分为典型组(A组)28例和非典型组(B组)7例,增强后记录各肿瘤结节的CT增强始增时间、峰值时间、始退时间及增强持续时间。所有病例均在行CT动态增强后行手术切除,术后标本送病理组织学检查与流式细胞术检查。分别记录各肿瘤结节细胞增殖的DNA各期比率以及增殖系数PI,计算2组间DNA非整倍体(异倍体)干系的百分比率。结果CT动态增强检查,始增时间2组间差异无统计学意义(P>0.05);峰值时间2组间差异无统计学意义(P>0.05);但始退时间A组明显短于B组(P<0.05);增强持续时间2组间差异具有统计学意义(P<0.01)。肿瘤细胞DNA分析,A组肝癌细胞表现为高增值的S期比率及增殖系数显著高于B组(P<0.05)。A组异倍体峰出现率高达53.57%(15/28),B组则无1例出现异倍体峰。结论CT动态增强持续时间在一定程度上反映了原发性肝细胞癌的生物学特性与恶性度。

] Objective To investigate the relationship between CT dynamic enhancement characteristics and DNA proliferation as well as its clinical value in patients with hepatocellular carcinoma （ HCC ）. Methods Thirty five patients with hepatocellular carcinoma （HCC） were examined by CT dynamic enhancement. The patients were divided into typical group （ group A） and untypical group （ group B ） according to CT dynamic enhancement. After the contrast agent was injected into dorsum manus vein, the contrast agent enhancement beginning time was examined by FCM. The rates of DNA content at different periods and the proliferation time, peak time ,wash -out time and persistence time were recorded and statistical analysis was conducted. All the nodes tissues were obtained by operation and the DNA content indexes （PI） were recorded and the aneuploid rates in both groups were counted. In each group of HCC, correlation analysis between enhanced persistence time and tumor cell S phase fraction as well as proliferation index were detected. The correlation analysis of all HCC nodes between enhanced persistence time and tumor cell S phase fraction as well as proliferation index were detected. Results For the examination of CT dynamic enhancement, there was no significant difference in the beginning time between the two groups （ P 〉 0.05 ）, and nor the peak time （ P 〉 0. 05 ）. But there was a significant difference in the wash - out time between the two groups （ P 〈 0.05 ）. There was a significant difference in the persistence time between the two groups（ P 〈 0.05 ）. For FCM examination, there was a significant difference in the tumor cell fraction and proliferation index at S phase between group A and B （ P 〈 0.05 ）. The aneuploid tumor cells were found in 15 HCC nodes of group A （15/28）, but no aneuploid cells were found in group B. In all thirty five HCC tumor nodes,the correlation between enhanced persistence time and tumor cell proliferation index had statistical significance（ P 〈 0.05 ）. Conclusion The investigation shows that there is an negative correlation between enhanced persistence time and tumor cell S phase proliferation index in HCC nodes. The enhanced persistence time may be related to the tumor malignancy at some degree. The shorter persistence time, the more malignant the tumor.