磁共振多回波R2＊技术无创评估肝细胞癌血氧水平及其临床意义

Evaluation of blood oxygen level in hepatoceHular carcinoma with noninvasive magnetic resonance multi-echo 112 ＊ technique and its clinical significance

目的 利用MR多回波R2＊技术评估肝细胞癌（HCC）血氧水平,探讨其与临床、病理特征之间的关系.方法 2007年1月至2009年12月在山东大学齐鲁医院行手术切除、并经病理证实的肝细胞癌病例46例（46个病灶）,手术前行MR多回波R2＊扫描.在R2＊图和T2＊图上测量HCC、肝实质、脾及脊柱旁骨骼肌的T2＊和R2＊值,并计算该值的HCC/肝、HCC/脾及HCC/肌比值.临床资料记录患者的甲胎蛋白（AFP）水平、病灶大小、病理分级、有无包膜、肝硬化、腹水、门静脉癌栓及周围子灶等情况.将HCC的T2＊、R2＊值及其相关参数与以上临床、病理特征进行对照分析.结果 HCC的R2＊值〈肝和脾T2＊值则相反（P〈0.05）.在AFP阳性和阴性组,HCC/肌R2＊比值分别为0.81±0.26、1.23±0.39,差异有统计学意义（P=0.047,t=2.248）;在有、无包膜组,HCC/肌R2＊比值分别为0.83±0.24、1.23±0.43,差异有统计学意义（P=0.046,t=2.257）;在有、无肝硬化组,HCC/脾R2＊比值分别为1.01±0.58、0.53±0.17,HCC/脾T2＊比值分别为1.42±0.92、2.64±1.15,差异均有统计学意义（P分别为0.035、0.036,t为2.247、2.230）.在有、无周围子灶组,HCC/肌T2＊比值为1.18±0.47、2.24±1.71（P=0.048,t=2.115）,在有、无门静脉癌栓组,T2＊值分别为（27.24±11.90）ms,（46.70±38.40）ms（P=0.049,t=2.046）,差异均有统计学意义.但各测量值在Edmondson分级、有无腹水之间差异无统计学意义（P〉0.05）,与病灶大小也未见相关性（P〉0.05）.结论 磁共振血氧水平参数R2＊、T2＊相关测量值与HCC的临床、病理特征具有一定的关系,HCC血氧水平受多种因素的影响.

Objective To probe the relationship of clinical and pathological features of hepatocellular carcinoma （ HCC） with the blood oxygen level by the technique of noninvasive magnetic resonance multi-echo R2 ＊ . Methods Multi-echo R2 ＊ sequence was carried out pre-operatively in a total of 46 patients with pathologically proved HCC. The T2 ＊ and R2 ＊ values of HCC, liver, spleen and paraspinous muscle on T2 ＊ and R2 ＊ maps and the ratios of HCC to liver （ H/L）, spleen （ H/S） and muscle （ H/M） were calculated. Different groups were defined according to such clinical parameters as the serum AFP level, lesion dimension, Edmondson＇s grade, ascites, capsula, liver cirrhosis, intrahepatic daughter foci or tumor-emboli in portal vein respectively. The differences in T2 ＊ and R2 ＊ values and the ratios between different groups were analyzed. Results In contrast with T2 ＊ value, the R2 ＊ value of HCC was less than that of liver or spleen （P 〈 0.05）. Difference in R2 ＊ ratio of H/M （0. 81 ± 0. 26 vs 1. 23 ± 0. 39） was found between positive and negative groups of AFP （P = 0. 047, t = 2. 248 ）. And so was the same difference （0. 83 ±0. 24 vs 1. 23 ±0. 43） between the lesions with or without capsula （P =0. 046, t = 2. 257）. The R2 ＊ ratio of H/S in hepatic cirrhosis group （1. 01 ±0. 58） was higher than that in non- cirrhosis one （ 0. 53 ± 0. 17） （P = 0. 035, t = 2. 247） whereas the T2 ＊ ratio of H/S was reversed （1.42 ± 0. 92 vs 2. 64 ± 1. 15） （P =0. 036, 1=2. 230）. The differences in T2 ＊ ratio of H/M in the group with or without intrahepatic daughter foci （1. 18 ± 0. 47 vs 2. 24 ± 1. 71 ） （ P = 0. 048, t = 2. 115 ） , and in T2 ＊ value in the group with or without tumor-emboli in portal vein （27. 24 ± 11. 90 ms vs 46. 70 ±38. 40 ms） （P =0.049, t =2.046） were shown to be significant However, no differences in MR parameters between other groups were observed （P〉0. 05）. Conclusion The blood oxygen level parameters, R2 ＊ and T2 ＊ values and the ratios are related to some clinical and pathological features of HCC. And the blood oxygen level is affected by multiple factors.