肝细胞癌经导管动脉化疗栓塞后磁共振扩散加权成像与病理对照研究  

Comparison between pathological findings and MR diffusion-weighted imaging in primary hepatocellular carcinoma after transcatheter arterial chemoembolization

作　　者：肖运平[1] 肖恩华[1] 罗建光[1] 卞读军[1] 李默秋[2] 贺忠[1] 尚全良[1] 梁斌[1] 

机构地区：[1]中南大学湘雅二医院放射科,长沙410011 [2]中南大学湘雅二医院病理科,长沙410011

出　　处：《中华肿瘤杂志》2008年第12期914-916,共3页Chinese Journal of Oncology

基　　金：国家自然科学基金资助项目（30070235、30470508、30870695）;湖南省自然科学基金资助项目（06JJ20081）;湖南省中医药管理局科研基金资助项目（202064、204057）;湖南省科技计划项目（04-SK-306-2）

摘　　要：目的探讨肝细胞癌（肝癌）经导管动脉化疗栓塞（TACE）后磁共振扩散加权成像（MRDWI）表现的病理基础。方法15例经TACE后行Ⅱ期切除的肝癌患者，术前24～48h进行MRDWI，对标本进行大体病理、HE染色及碱性成纤维细胞生长因子（bFGF）免疫组化染色观察。结果15例患者中，12例存活瘤区为高信号，3例为等信号。8例凝固性坏死区为低信号，6例为等信号，1例呈高信号。肿瘤存活区表观扩散系数（ADC）值为（1．42±0．16）×10^-3mm^2／s，坏死区ADC值为（1．58±0．18）×10^-3mm^2／s，两者差异有统计学意义（P〈0．05）。TACE术后、Ⅱ期手术切除前的ADC值与肝癌的Edmondson分级、坏死程度有关（均P〈0．05）。15例患者中，10例肿瘤存活区bFGF蛋白强表达，5例弱表达，肝癌组织bFGF蛋白表达与其ADC值呈负相关（r=-0．552，P=0．033）。结论肝癌TACE后，MRDWI能较好地鉴别存活与坏死肿瘤组织。Objective To explore the pathological basis of diffusion-weighted imaging （DWI） findings in hepatocellular carcinoma （HCC） after transcatheter arterial chemoembolization （TACE）. Methods DWI was performed in 15 patients with HCC treated by TACE within 24-48 hours before II-phase operation. The DWI findings of the liver lesions were analyzed and correlated with pathological findings including macroscopic observation, HE staining and immunohistochemical staining for bFGF. Results （1） The viable tumor area showed mostly hypersignal intensity （ 12/15 ）, whereas coagulative necrotic lesions showed hyposignal （8/15） or isosignal intensity （6/15）. The ADC values of zones of viable tumor and necrosis in tumor were （ 1.42±0.16）×10^-3mm^2/s and （1.58±0.18）×10^-3mm^2/s, respectively. There was a significant difference of ADC values between the two zones （t = 2. 618 ,P 〈 0.05 ）. （2） There was a significant difference in ADC values of viable tumor between well and poorly differentiated tumors （ t = - 2. 646,P 〈 0.05 ）. The distinction of ADC values of the whole tumor was significant among tumors with different degree of necrosis （X^2 = 7. 236,P 〈 0.05 ）. （3） A negative correlation was observed between bFGF protein expression index and ADC values of viable parts of the tumors in the study group （r = - 0.552 ,P =0.033 ）. Conclusion DWI shows certain characteristic features of the HCC after TACE, and can be used to distinguish viable and necrotic tumor tissues in HCC after TACE.

关 键 词：肝肿瘤 化疗栓塞 磁共振扩散加权成像 病理学 

分 类 号：R686[医药卫生—骨科学]