原发性肝细胞癌锰福地匹三钠增强MRI强化指数与其分化程度的相关性探讨

Primary hepatocellular carcinoma: investigation on the correlation between enhancement index on MnDPDP enhanced MRI and tumor differentiation

目的 探讨原发性肝细胞癌 (HCC)的锰福地匹三钠 (MnDPDP)增强MRI强化指数与其分化程度的相关性。方法 将 4 3个由MRI检出并经手术切除治疗的HCC病灶强化指数 ,与其病理分化程度分级进行对照。于轴位正中层面图像上将 4 3个HCC病灶分为均匀强化和不均匀强化 ;将后者分成高、等、低 3个区域 ,并分别计 3、2、1分 ;按不同信号强度区所占该层面的百分比计算不同区域的分值 ,将不同区域的分值相加即得“病灶强化指数” ,最后将病灶强化指数与其病理分级相对照。病理检查取材部位与不同强度信号区相对应 ,并包括瘤 肝交界处。结果 对 4 3个HCC的 113处进行了Edmondson和Steiner分级 :Ⅰ级 13处 ,Ⅰ～Ⅱ级 7处 ,Ⅱ级 5 0处 ,Ⅱ～Ⅲ级 2 2处 ,Ⅲ级 19处 ,Ⅲ～Ⅳ级 1处 ,Ⅳ级 1处。高信号、等信号和低信号分别为 81、17和 15处。增强后HCC高、等、低信号区与其分化程度之间具有显著相关性 (χ2 =2 6 .75 ,P <0 .0 0 5 )。病灶强化指数与其分化程度之间具有显著相关性 (χ2 =7.94 ,P <0 .0 0 5 )。结论 HCCMnDPDP增强MRI强化指数与其分化程度具有显著相关性。

Objective To explore the correlation between the enhancement index of HCC on MnDPDP enhanced MRI and the tumor differentiation. Methods The enhancement indice of 43 HCCs in 34 cases detected on MRI with MnDPDP confirmed surgico-pathologically were analyzed and compared with the HCC differentiation. The 24-hour delayed T 1W SE images enhanced with MnDPDP were employed in this study. The enhancement findings of the lesion foci at their midaxial sections in 43 HCCs were blindly divided into two groups: homogeneity and heterogeneity by 3 experienced radiologists,and for the latter,the regions with different signal intensities (low,iso- or high) were scored 1 to 3 credits. Then,all the lesions including the homogeneous ones were scored and the credits were weighted proportionally by the size of areas in which the different signal intensity dominated. At last,the scores for different areas were summed up to obtain 'Enhancement Index' for the HCC focus respectively. And eventually,the enhancement index for HCC was compared with HCC pathologic grading. The sites for specimen collection were corresponding to the regions with different signal intensities,and the conjunction area between the tumor and liver was also examined pathologically. Results The overall sites for pathologic examination were 125 for the 43 HCCs. The sites of HCCs dominated by fatty changes (2),hyaline-cells (3) and necroses (7) were rejected. Edmondson and Steiner grading was performed for the rest 113 sites of HCC specimens as follows: Ⅰ(13),Ⅰ-Ⅱ(7),Ⅱ(50),Ⅱ-Ⅲ(22),Ⅲ(19),Ⅲ-Ⅳ(1),and Ⅳ(1). On MnDPDP enhanced MR images,the regions of HCCs in high,isointense,and low signal intensity were 81,17,and 15,respectively. There was a significant correlation between the signal intensity on MnDPDP enhanced MRI and the tumor differentiation of HCC on region-by-region basis (χ 2=26.75,P<0.005). And the HCC enhancement index with MnDPDP was significantly correlated with the tumor differentiation (χ 2=7.94,P<0.005). Conclusion The enhancement index of HCC on MnDPDP enhanced MRI was well correlated with the tumor differentiation.