动态增强CT预测原发性肝癌微血管的侵犯

Prediction of Microvascular Invasion of Hepatocellular Carcinoma by Dynamic Enhanced CT Scanning

目的探讨动态增强cT观察原发性肝癌的微血管侵犯价值。方法选取行根治性切除的原发性肝癌患者119例。术前行动态增强CT扫描，观察动态增强cT图像上病灶大小、数目、包膜，病理上记录肿瘤有无微血管侵犯及肿瘤分化程度。结果cT上共检出病灶129个，病理上70个病灶显示具有微血管侵犯，59个病灶为阴性。微血管侵犯组，肿瘤直径（4．8±2．7）cm，而非微血管侵犯组，肿瘤直径为（3．3±2．0）cm，P=0．039（F=6．47）。随着肿瘤分化程度降低，微血管侵犯发生率明显升高。肿瘤分化程度与微血管侵犯密切相关，P=0．045（X^2=12．21）。包膜完整性分级≥3的病灶56个，20个病灶显示微血管侵犯，73个病灶包膜完整性分级为1～2级的病灶，50个病灶显示微血管栓子，随着包膜完整性分级降低，微血管发生率明显升高，P=0．003（X^2=15．34），二者具有统计学差异。结论肿瘤大小、数目、分化程度及有无包膜与肿瘤微血管侵犯密切相关，通过动态增强CT，可以预测肿瘤微血管侵犯情况。

Objective To assess the value of dynamic enhanced CT scanning in predicting microvascular invasion of hepatocellular carcinoma Methods A total of 119 patients with primary hepatic carcinoma who were planed to receive radical surgery were enrolled in this study. Preoperative dynamic enhanced CT scanning was carried out in all patients. The tumor size, number and capsule integrity were assessed on dynamic enhanced CT scans. The results were correlated with pathologic findings, including tumor differentiation degree and microvascular invasion. Results A total of 129 lesions were detected on CT scans. Pathologically, positive microvascular invasion was seen in 70 lesions, while negative microvascular invasion in 59 lesions. The diameter of tumor in positive group and negative group was （4.8 ＋- 2.7 ） cm and （ 3.3 ± 2.0） cm respectively, and the difference was statistically significant （ P = 0. 039, F = 6.47 ）. With the decrease in tumor differentiation degree, the incidence of microvascnlar invasion obviously increased. A close correlation existed between the tumor differentiation degree and the incidence of microvascular invasion （ P = 0. 045, X^2 = 12.21 ）. Of 56 lesions with 〉i 3 grade of capsule integrity, microvascular invasion was detected in 20, while among 73 lesions with 1 - 2 grade of capsule integrity, 50 showed signs of microvascular invasion, indicating that with the decrease in the capsule integrity grade, the incidence of microvascular invasion markedly increased, and the difference was statistically significant （ P = 0. 003, X^2 = 15.34）. Conclusion The tumor size, number, tumor differentiation degree and capsule integrity grade bear a close relationship to the occurrence of microvascular invasion. Dynamic enhanced CT scanning can effectively predict the microvascular invasion in hepatoeellular carcinomas.