肝癌边缘双期CT强化特征与组织病理学的相关性

Correlation between dual-phases CT enhancement patterns and histopathology in the rim of hepatocellular carcinoma

目的探讨原发性肝细胞癌(primary hepatocellular carcinoma,PHCC)64排螺旋CT双期边缘部强化特征的组织病理学基础。方法 52例经手术病理或穿刺活检证实的PHCC患者术前行全肝CT平扫及双期增强扫描,观察其边缘部CT强化方式;手术标本行常规HE染色和HapPar1、CD34免疫组化染色,观察其各种病理改变。结果 CT平扫病灶边缘清楚者,病理上肿瘤多有或薄或厚包膜,肿瘤以膨胀性生长为主;而边缘不清的病理上肿瘤浸润性生长多见;动态增强后肿瘤边缘不清或呈高密度者,癌细胞浸润率高,边缘新生血管丰富,转移几率高,预后差;而呈低密度者癌细胞浸润率低,新生血管较少,转移几率低,预后相对较好。结论动态CT双期增强扫描能很好地显示肿瘤边缘的强化特征,进而反映其组织病理学改变,对临床治疗方式的选择意义重大。

Objective To investigate the histopathologic foundation of the rim enhancement characteristics of primary hepatocellular carcinoma in dual-phases with 64-slice spiral CT. Methods The characteristics of CT enhancement in 52 cases of hepatocellular carcinoma were studied, which confirmed by surgery or biopsy with preoperative CT scan and contrast CT of hepatic dual-phases. The pathological changes of fresh surgical specimens were observed by routine HE staining and HapParl, CD34 immunohistochemistry. Results The tumor with clear boundary shown on plain CT was on expansive growth , with thin or thick envelope on pathology, and the tumor with unclear boundary was in invasive growth on pathology. There was higher infiltration rate and higher metastasis rate in tumor with unclear boundary and high-density tumor, with rich angiogenesis in boundary, the tumor＇ s prognosis was not good. There was lower infiltration rate and lower metastasis rate in low-density tumor with fewer new blood vessels, the tumor＇s prognosis was comparatively good. Conclusion Dynamic enhanced CT scan can show the CT enhancement characteristics of the tumor boundary, reflect the histopathological changes and has great significance in guidance for clinical treatment modalities.