肝细胞肝癌的IVIM-DWI多定量参数与病理的相关性研究

The correlation between IVIM-DWI multi-quantitative parameters and pathology of hepatocellular carcinoma

目的探讨体素内不相干运动-扩散加权成像(IVIM-DWI)多定量参数对肝细胞肝癌(HCC)微循环状态的评估价值。方法前瞻性纳入行腹部常规MRI及IVIM-DWI检查且经手术病理证实的HCC病人30例,其中男17例,女13例,平均年龄(56.13±7.45)岁。在肝脏IVIM-DWI中分别测量肿瘤实质区多定量参数[表观扩散系数(ADC)、扩散系数(D)、假扩散系数(D^*)和灌注分数(PF)]值。对HCC行病理分级,并采用Weidner方法对CD34-微血管密度(CD34-MVD)、α-平滑肌激动蛋白(α-SMA)进行计数。采用Pearson相关或Spearman秩相关分析多定量参数与HCC的病理分级及其CD34-MVD、α-SMA的相关性,采用多组间方差分析比较HCC不同病理分级间多定量参数值及病理免疫组化指标的差异。结果ADC、D值与CD34-MVD、α-SMA呈负相关,D^*、PF值分别与CD34-MVD、α-SMA呈正相关。ADC、D值与HCC病理分级呈中度负相关,D^*、PF值与HCC病理分级呈中度正相关,且ADC、D及PF值在不同病理分级间差异有统计学意义(P<0.05),随着病理级别的增高,ADC、D值逐渐减小,PF值逐渐增大,D*值在不同病理分级组间差异无统计学意义(P>0.05)。CD34-MVD、α-SMA与HCC病理分级呈强正相关,且在不同病理分级间差异有统计学意义(P<0.05)。结论IVIM-DWI的多定量参数可以反映HCC的病理分级及微循环功能状态,为HCC的诊断与治疗评估提供活体检测的客观指标。

Objective To explore the value of IVIM-DWI multi-quantitative parameters in evaluating microcirculation of hepatocellular carcinoma(HCC).Methods Thirty cases of HCC confirmed by operation and pathology were prospectively included.All patients underwent routine MRI and IVIM-DWI examination of abdomen.There were 17 males and 13 females,mean age 56.13±7.45 years.Multiple quantitative parameters of tumor parenchyma[apparent diffusion coefficient(ADC),diffusion coefficient(D),false diffusion coefficient(D^*)and perfusion fraction(PF)]were measured from IVIM-DWI.The HCC was graded by pathology,and the pathological immunohistochemistry indexes CD34-microvascular density(CD34-MVD)and α-smooth muscle actin(α-SMA)were counted with Weidner method.Pearson correlation or Spearman rank correlation were used to analyze the correlation between multiple quantitative parameters and pathological grade of HCC,CD34-MVD,and α-SMA.Multivariate analysis of variance was used to compare the differences in multiple quantitative parameters and pathological immunohistochemical indexes among different pathological grades of HCC.Results The ADC and D values were negatively correlated with CD34-MVD andα-SMA,the D^* and PF values were positively correlated with CD34-MVD and α-SMA.The ADC and D values moderately negatively correlated with pathological grade of HCC,the D^* and PF values moderately positively correlated with pathological grade of HCC.The ADC,D and PF values differed statistically among the different pathological grades(P<0.05).With the increase of pathological grade,the ADC and D values gradually decreased,PF value gradually increased,D^* value had no statistical significance among different pathological grades(P>0.05).The CD34-MVD and α-SMA strongly positively correlated with pathological grades,and the CD34-MVD and α-SMA values differed significantly among pathological grades(P<0.05).Conclusion The quantitative parameters of IVIM-DWI can reflect the pathological grade and microcirculation function of HCC,and provide objective indicators for the diagnosis and treatment of HCC.