动态增强MR量化参数无创评估肝细胞癌生物学行为

Evaluation of the biological behaviors of hepatocellular carcinoma using quantitative parameters of dynamic contrast-enhanced MRI at 3.0 Tesla

目的：探讨动态对比剂增强MR技术量化参数在评估肝细胞癌（HCC）生物学行为中的价值.方法：选取行手术切除并经病理证实的肝细胞癌46例,术前行MR动态对比剂增强扫描,然后分析测量病灶和周围肝实质的动态增强曲线类型、最大上升斜率（MSI）、信号增强率（SER）、正性增强积分（PEI）、最大下降斜率（MSD）和峰值（PV）.根据患者手术和病理结果测量病灶最大直径,病理分级采用Edmondson法分为4级.根据病灶有无包膜及肝硬化进行分组;凡出现门静脉癌栓、周围淋巴结转移或周围子灶等之一者定为侵袭转移组,否则为阴性组.分析动态增强MR各测量参数与HCC手术和病理资料之间的关系.结果：HCC的MSI、PEI、MSD和PV均大于肝实质,差异具有统计学意义（P＜0.05）,但SER在两者之间的差异无统计学意义（P＞0.05）.MSI和PV在阴、阳性侵袭转移组,MSI和PEI在有、无包膜组,MSI、PEI和PV在有、无肝硬化组之间差异均具有统计学意义（P＜0.05）.病灶直径也与MSI、PEI呈正相关关系（r值分别为0.369和0.325,P值分别为0.011和0.026）.另外,在侵袭转移组,Ⅰ、Ⅱ和Ⅲ型曲线分别占85.7%（6/7）、75.0%（15/20）、31.6%（6/19）,与无侵袭转移组之间差异具有统计学意义（χ^2=10.63, P=0.007）.本研究中其他动态增强指标在以上各组之间及Edmondson分级及有、无腹水组之间的差异均无统计学意义（P＞0.05）.结论：利用动态对比剂增强MR扫描技术可在一定程度上对HCC的生物学行为进行无创性量化评估.

Objective： To investigate the value of dynamic contrast-enhanced MRI （DCE-MRI） technique in evaluating quantitatively the biological behaviors of hepatoeellular carcinoma （HCC）. Methods：Three-dimensional DCE-MRI scanning was carried out before surgery in 46 patients with HCC. The patterns of signal intensity-time curve, maximum slop of increase （MSI）, signal enhancement ratio （SER）, positive enhancement integral （PEI）, maximum slop of decrease （MSD） and peak value （PV） were obtained in both lesion and normal hepatic tissue at a workstation. The maximum diameter and Edmondson＇ s grading were gotten according to the biopsy and HE staining, and some groups were defined according to the ascites, eapsula and cirrhosis. The infillration group was obtained when the intrahepatic daughter loci, tumor-emboli in portal veins and lymphatic metastasis occurred. All these clinical data were compared with the measured parameters from DCE-MRI. Results.. The MSI, PEI, MSD and PV of HCC were more than those of liver except for SER statistically （ P 〈0.05）. The differences in MSI and PV between infiltration groups, in MSI and PEI between capsula groups, and in MSI, PEI and PV between liver cirrhotic groups were seen （ P 〈0.05）. The positive correlations between lesion diameter and MSI, and PEI were also found （ r were 0. 369 and 0. 325, P value were 0. 011 and 0. 026 respectively）. In addition, the enhanced curve type Ⅰ , Ⅱ and Ⅲ were 85.7% （6/7）, 75.0% （15/20） and 31.6% （6/19） in infiltration groups, and a difference was also identified between the infiltration and non infiltration groups （ Х^2 =10.63, P=0. 007）. No difference in other parameters was found between the groups above, and in all parameters between Edmondson grade and ascites groups （ P 〉0.05）. Conclusion： DEC-MRI technique may be used to evaluate noninvasively the biological behaviors of HCC to some extent.