肝细胞肝癌MR DWI表现与病理学等级关系的分析

Retrospective analysis of the relationship between manifestation of MR DWI and histopathologic grade of primary hepatic carcinoma

目的探讨肝细胞肝细胞肝癌的弥散加权成像(DWI)表现与组织病理学等级之间的关系,同时评估T加权像与弥散系数(ADC)的测量值,以及它们之间的关系。方法 88例100个手术切除肝癌结节的MR检查。病理检查提示20个高分化、46个中分化和34个低分化肝细胞肝癌(HCC),评估其信号强度的发生率和信号强度与组织病理学等级之间的关系,以及弥散系数和组织病理学等级的关系。结果在DWI上,100个HCC与背景肝比较,表现为低到等信号的9个,略高信号22个,显著高信号69个。91%(91/100)的HCC显示信号强度高于周围肝实质。统计分析显示,DWI的比率显著高于快速自旋回波T加权像(P<0.01)。在DWI上,肿瘤随组织病理学等级的升高而显示较高的信号(P<0.05),但在T2WI上看不到这种倾向。ADC测量提示高分化、中分化和低分化HCC的平均ADC,分别约为1.44×10-3mm2/s、1.45×10-3mm2/s和1.36×10-3mm2/s。结论 HCC的组织病理学等级与ADC之间不相关;但HCC随组织病理学等级升高在DWI上显示较高的信号。

Objective To determine the relationship between the primary hepatocellular carcinoma on DWI with histopathological grade of each of the nodules, and assess the T2WI and measurement of the ADC, as well as the relationships between them. Methods MR data including DWI and T2WI of 100 surgically resected hypervascular HCCs in 88 patients were retrospectively reviewed. Pathologic examinations revealed 20 well-,46 moderately,and 34 poorly differentiated HCCs. The incidence of each signal intensity and the relationship be- tween signal intensity and histopathologic grade were assessed for each sequence. The relationship between the ADC and histopathologic grade was also evaluated. Results On DWI,9 of 100 HCCs appeared hypo- to isoin- tense ,22 tumors appeared slightly hyperintense, and the remaining 69 tumors appeared obviously hyperintense to the surrounding liver. Overall, 91.0% （91/100） of H CCs showed hyperintensity to the surrounding hepatic pa- renchyma. Statistical analysis showed that this rate on DWI was significantly higher than that on T2 TSE imaging （ P 〈 0. 01 ）. On DWI, the tumors tended to show a brighter signal with rising histopathologic grade （ P 〈 0.05 ）, but this trend was not observed on T2 WI. ADC measurements revealed that the mean ADCs of well-, moderately, and poorly differentiated HCCs were approximately 1.44×10^-3mm2/s,1.45×10^-3mm2/s and 1.36×10^-3mm2/s, respectively. Conclusion The histopathologic grade of HCC had no correlation with the ADC, but HCC tumors tended to show a higher signal on DWI as the histopathologic grade rose.