肝细胞癌低场MRI边缘表现与病理基础对照

Hepatoellular Carcinoma:Tumor Border findings on Lower Field MR Imaging with Pathologic Correlation

【目的】了解肝细胞癌(HCC)在低场MRI上的边缘形态及其病理基础。【方法】分析33例手术病理证实的肝细胞癌在术前MRI的边缘形态并对24例标本MRI与病理基础对照研究。【结果】①33例HCC术前MRI的132个边缘方位在T2WI上分为3种:边缘清楚无分叶82个(621%)、边缘清楚伴分叶20个(152%)、边缘不清30个(227%);②HCC边缘形态在术后标本MRI扫描与术前MRI扫描的相同率为792%;③24个标本MRI扫描与病理对照:MRI上肿瘤边缘清楚无分叶的以完整包膜为主,占882%、肿瘤边缘清楚伴分叶以包膜不完整或多结节状改变为主,占675%、肿瘤边缘不清则以无包膜多见,占667%。肿瘤边缘清楚无分叶的85个方位点中病理上癌旁周围肝组织发现癌细胞的有12个方位点(占141%),而边缘清楚伴分叶的40个方位点及边缘不清的45个方位点癌旁发现癌细胞的百分率则分别为425%及556%。【结论】HCC在低场MRI的T2WI上的边缘形态分类能够很好地反映病理上肿瘤包膜的完整程度及肿瘤向周围肝组织浸润生长情况。

Objective To study the tumor border patterns of hepatocellular carcinoma (HCC) on lower field MRI and its pathological basis. Method Tumor border patterns on MRI of 33 cases of HCC were analyzed, and MRI pathologic correlation study of 24 resected HCC specimens were performed. Results ①The tumor border patterns of the 33 HCC on T 2WI were divided into three groups:well defined nonlobular margin (82/132 quadrants; 62.1%),well defined lobular margin (20/132 quadrants; 15.2%) and ill defined margin (30/132 quadrants;22.7%). ②The rate of same tumor border pattern of the in vivo and in vitro MRI HCC was 79.2%. ③Correlation between patterns of tumor border on MR scan and the pathological capsular patterns:most of the tumors with well defined nonlobular borders(88.2%) had complete capsules. Tumors with incomplete or irregular capsules were most commonly seen as well defined, lobular borders (67.5%) whereas most tumors without capsules had ill defined borders (66.7%). Correlation between the patterns of tumor border on MR studies and incidences of tumor invasion of surrounding hepatic tissues:scattered tumor cells in the surrounding hepatic tissues were found in 12/85(88.2%) areas with well defined nonlobular borders; 17/40(42.5%) areas with well defined, lobular borders; 25/45(55.6%) areas with ill defined borders. Conclusion The patterns of tumor borders on lower field MRI can accurately reflect circumstance of the tumor capsules, the tumor cell classification and the incidences of tumor invasion of surrounding hepatic tissue.