A correlation of computed tomography perfusion and histopathology in tumor edges of hepatocellular carcinoma

BACKGROUND： The peripheral morphologic characteristics of hepatocellular carcinoma （HCC） reflect tumor growth patterns. Computed tomography （CT） perfusion is a new method to analyze hemodynamic changes in tissues. We assessed the relationship between CT perfusion and histopathologic findings in the periphery of HCC lesions. METHODS： Non-contrast CT, enhanced dual-phase CT, and CT perfusion were performed on 77 subjects （47 patients and 30 controls）. Based on the imaging findings of enhanced dual- phase CT, the tumor edges were classified into three types： type Ⅰ （sharp）; type Ⅱ （blurry）; and type Ⅲ （mixed）. The CT perfusion parameters included hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion. The tissue sections from resected specimens were subjected to routine hematoxylin and eosin staining and immunohistochemical staining for CD34. The correlations between microvessel density （MVD） and the CT perfusion parameters were analyzed using Pearson＇s product-moment correlation coefficient. Changes in the perfusion parameters in tumor edges of different tumor types were evaluated. RESULTS： Type Ⅰ （sharp）： the pathologic findings showed fibrous connective tissue capsules in the tumor edges, and an MVD 〈30/ram2. Type Ⅱ （blurry）： the histology showed that the edges were clear with no capsules and an MVD 〉30/ram2. Type Ⅲ （mixed）： the pathology was similar to that of types I and II, and an MVD 〉30/mm~. Hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion were significantly increased in the tumor edges of HCC patients compared to those of the controls （P〈0.05）. The correlation between CT perfusion parameters and MVD was higher in blurry tumor edges of type II than in those of types Ⅰ or Ⅲ. CONCLUSION： CT perfusion imaging of tumor edges may be helpful in revealing histopathological features, and indirectly reflect angiogenic changes of HCCs.

High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists： Correlation with Cross-sectional Anatomy

Background：The injury of the triangular fibrocartilage complex （TFCC） is a common cause of ulnar-sided wrist pain.The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging （MRI） could demonstrate the detailed complex anatomy of TFCC in Chinese.Methods：Fourteen Chinese cadaveric wrists （from four men and three women;age range at death from 30 to 60 years;mean age at 46 years） and forty healthy Chinese wrists （from 20 healthy volunteers,male/female：10/10;age range from 21 to 53 years with a mean age of 32 years） in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study.All cadavers and volunteers had magnetic resonance （MR） examination of the wrist with coronal T 1-weighted and proton density-weighted imaging with fat suppression in three planes,respectively.MR arthrography （MRAr） was performed on one of the cadaveric wrists.Subsequently,all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw （six in coronal plane,four in sagittal plane,and four in axial plane）.The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists.Results：Triangular fibrocartilage,the ulnar collateral ligament,and the meniscal homolog could be best observed on images in coronal plane.The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane.The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane.The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr.Conclusion：High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.

Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture

Background：Hand injuries are very common in sports,such as skiing and ball sports.One of the major reasons causing hand and finger deformity is due to ligament and tendon injury.The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging （MRI） can demonstrate the complex anatomy of the fingers and thumb,especially the tendons and ligaments,and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities.Methods：Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers.A total of 20 healthy volunteers＇ hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study.All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression （PD FS） in axial,coronal,and sagittal plane,respectively.Subsequently,all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw （six in coronal plane,six in sagittal plane,and four in axial plane）.The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament （UCL） at the metacarpal phalangeal joint （MCPJ） of thumb between 20 healthy volunteers and 44 patients （confirmed by surgery） were analyzed.Results：The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers＇ hands showed uniform low-signal intensity on all the sequences of the MRI.Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb,12 cases with UCL injury at MCPJ of the thumb （Stener lesion =8 and non-Stener lesion=4）,6 cases with the central slip injury,12 cases with terminal tendon injury,and 14 cases with flexor digitorum profundus injury.The ligaments and tendons disruption manifested as increased signal intensity and poor definition,discontinuity,and heterogeneous signal intensity of the involved ligaments and tendons.Conclusions：Sports injury-related fingers and thumb deformity are relatively common.MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb.It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.