MRI评价肝细胞癌组织学分化程度的价值

Magnetic Resonance Imaging in Predicting Histopathological Differentiation of Hepatocellular Carcinoma

【目的】通过分析肝细胞癌(HCC)MRI的主要征象与不同组织学分化程度之间的关系,探讨MRI在评价肝细胞癌组织学分化程度中的价值。【方法】将病理证实的229例HCC分为3组:高分化组(34例),中分化组(170例),低分化组(25例)。均行常规MRI及DWI检查,分析HCC瘤灶主要征象与HCC组织学分化程度的关系。【结果】229例HCC中(1)HCC瘤灶的分叶程度与组织学分化程度之间呈较弱的负相关关系(r=-0.37,P=0.000);HCC的T1WI信号强度与组织学分化程度之间呈较弱的正相关关系(r=0.292,P=0.000);HCC的T2WI信号强度与组织学分化程度之间呈较弱的负相关关系(r=-0.207,P=0.002)。HCC的DWI目测信号强度与组织学分化程度之间呈较弱的负相关关系(r=-0.317,P=0.000)。(2)HCC的"包膜"完整性,血供方式与组织学分化程度之间无显著相关关系(P>0.05)。(3)在HCC瘤灶的分叶程度、T1WI信号强度、T2WI信号强度和DWI目测信号强度中,HCC瘤灶的分叶程度是影响组织学分化程度的最显著因素(OR1=0.15,OR2=0.25,P<0.05)。【结论】MRI中HCC的分叶程度、T1WI、T2WI、DWI的目测信号强度有利于预测HCC组织学分化程度,其中HCC分叶程度为最主要的征象;然而,根据常规MRI检查及DWI的目测信号强度,而正确预测HCC的组织学分化程度是有限的,应该综合多种征象分析。

[Objective] The objective was to determine the value of MRI in analyzing the relationship between some of the main imaging signs of MRI and the histopathologieal differentiation of Hepatocellular Carcinoma （HCC）. [ Methods ] 229 HCC confirmed by histopathology were classified into three groups according to their histopathological differentiation： well （n = 34）, moderately （n = 170） and poorly differentiated （n = 25）. All patients received MRI （including conventional MRI and DWI） before the operation. Some of the main MR imaging signs of the HCC were analyzed. [ Results ] （ 1 ） The degree of lobulated HCC shows weaker inverse correlation with histopathological differentiation （r = -0.37, P = 0.000）. On T1WI, the signal intensity of HCC shows weaker positive correlation with histopathologieal differentiation （r = 0.292, P = 0.000）. On T2WI, the signal intensity of HCC shows weaker inverse correlation with histopathological differentiation （r = -0.207, P = 0.002）. The visually evaluated signal intensity on DWI of HCC shows inverse correlation with histopathological differentiation （r = -0.317, P = 0.000）. （2） There was no significant correlation between the integrity of capsule, mode of blood supply of HCC and histopathological differentiation （P 〉 0.05 ）. （3）Among the four influential factors such as the degree of lobulated HCC, the signal intensity On T1WI , the signal intensity On T2WI and the visually evaluated signal Intensity on DWI of HCC, the first was the most important influential factors which correlated with histopathological differentiation of HCC （OR1 = 0.15, OR2 = 0.25, P 〈 0.05）. [Conclusion] It was beneficial to predict the histopathological differentiation of HCC by analyzing the degree of lobulated, the signal intensity on TIWI, the signal intensity on T2WI, and the visually evaluated signal intensity on DWI of HCC. The degree of lobulated HCC was the most important influential factors. However, predicting the correct histopathological differentiation of each HCC before surgery on the basis of MRI findings was difficult because of the large overlap among histopathological differentiation. As a result, it should incorporate a variety of MRI signs.