肝细胞癌多项MRI表现与癌细胞核DNA含量的多元线性回归分析  

Linear Regression Analysis on Many Dynamic MRI Features with Nuclear DNA Content in Hepatocellular Carcinomas

作　　者：孙黎明 徐坚民 李肃 龚静山 王晓玫 王新根 

机构地区：[1]暨南大学医学院附属深圳市人民医院放射科,深圳市518020 [2]暨南大学医学院附属深圳市人民医院病理科,深圳市518020 [3]暨南大学医学院附属深圳市人民医院中心实验室,深圳市518020

出　　处：《临床放射学杂志》2006年第7期634-638,共5页Journal of Clinical Radiology

摘　　要：目的 探讨肝细胞癌（hepatocellular carcinoma，HCC）多项MRI表现与癌细胞核DNA含量及病理学表现的相关性。资料与方法 分析经手术及病理证实的43例HCC患者。根据肿瘤动态强化特征分为4型（Ⅰ型：肿瘤信号动脉期高于或等于肝实质，门脉期低于肝实质；Ⅱ型：肿瘤信号动脉期和门脉期均高于或等于肝实质；Ⅲ型：肿瘤信号动脉期低于肝实质，门脉期高于或等于肝实质；Ⅳ型：肿瘤信号动脉期和门脉期均低于肝实质）。同时观察动脉期肿瘤边缘强化情况、肿瘤强化方式和强化程度、大小、包膜、坏死、肝内子灶、门脉瘤栓。采用流式细胞仪（flow cytometry，FCM）测定石蜡包埋肿瘤标本的癌细胞核DNA含量，得出DNA指数（DNA index，DI）。分析MRI表现与DNA含量间的关系。结果 43例中Ⅰ型强化29例，Ⅱ型12例，Ⅲ型及Ⅳ型各1例。Ⅰ型强化HCC的DI显著高于Ⅱ型（P=0．009）。动脉期肿瘤边缘强化与非边缘强化间（P=0．005）、明显强化与轻度强化间（P=0．038）、强化不均匀与强化均匀间（P〈0．001）DI有统计学差异。肿瘤直径弓5cm、无包膜、有瘤内坏死、子灶或瘤栓，其DI明显高于肿瘤直径〈3cm（P=0．002）、有包膜（P=0．027）、无瘤内坏死（P=0．026）、无子灶或瘤栓（P=0．005）。肿瘤直径〈3cm与3．5cm间（P=0．192）以及3．5cm与〉5cm间（P=0．084）DI无统计学意义。经多元线性回归分析，肿瘤大小、包膜、动脉期强化方式、强化类型与DI相关，回归方程为：Y=-1．678＋0．279X1＋0．534X2＋0．668X3＋0．427X4。病理为Ⅲ、Ⅳ级的肿瘤DI明显高于Ⅰ、Ⅱ级（P=0．001）。结论 HCC多项MRI表现与癌细胞核DNA含量及病理分级有相关性，可在一定程度上间接反映HCC的恶性生物学行为，为临床选择治疗方案及评价预后提供信息。Objective To discuss the correlation of many dynamic MRI features with nuclear DNA content and pathology in hepatocellular carcinomas. Materials and Methods 43 patients with pathologically confirmed HCC were reviewed. The enhancement types of HCC were classified into four categories. Type Ⅰ ： hyper or isointensity on arterial phase （AP） and hypointensity on portal phase （PP） ; type Ⅱ ： hyper or isointensity on both AP and PP; type Ⅲ： hypointensity on AP and iso or hyperintensity on PP; type Ⅳ： hypointensity on both AP and PP. Enhancement type, pattern and of enhancement on AP, size, capsule, necrosis, satellite nodules and the portal vein embolus of HCC were analyzed. DNA index （DI） was measured by Flow Cytometry with paraffin embedded specimens of HCC. The relationship between MRI features and nuclear DNA content of HCC was analyzed. Results Of 43 cases, there were 29 cases of enhancement type Ⅰ , 12 cases of type Ⅱ , each one of type Ⅲ and type Ⅳ. DI of enhancement type Ⅰwas significantly higher than that of type Ⅱ （ P = 0.009）. The statistical differences were existed between DI of HCC with peripheral and nonperipheral enhancement （P =0.005）, markedly and slightly enhancement （P = 0.038）, homogeneous and inhomogeneous enhancement （ P 〈 0.001 ）. DI of tumor with diameter 〉 5.0 cm, necrosis, embolus, satellite nodules and without tumor capsule were significantly higher than that of tumor diameter 〈 3.0 cm （ P = 0. 002）, without tumor necrosis （ P = 0.026） and embolus （ P = 0.005） or satellite nodules （ P = 0.005）, with capsule （ P = 0.027）. There were no differences for DI of HCC between tumor diameter 〈 3.0 cm and diameter in 3.0 ～ 5 .0 cm （ P = 0.192）, between tumor diameter in 3.0 ～ 5 .0 cm and diameter 〉 5.0 cm （ P = 0.084）. Tumor size, tumor capsule, enhancement type and enhancement pattern were correlated with DI by multiple linear regression＇ s analysis, regression formula was Y = - 1. 678 ＋ 0. 279X1 ＋

关 键 词：肝细胞癌 磁共振成像 动态增强 脱氧核糖核酸 流式细胞仪 

分 类 号：R735.7[医药卫生—肿瘤]