肝细胞肝癌CT全肿瘤灌注测量值与MVD及其与病理分化程度的相关性

摘要

目的 探讨肝细胞肝癌320排CT全肿瘤灌注测量值与MVD的关系,分析肝细胞肝癌不同病理分级与MVD的相关性.方法 收集56例行320排容积CT灌注成像的肝细胞肝癌患者,采用全肿瘤测量法计算瘤体的肝动脉灌注量(HAP)、门静脉灌注量(PVP)及肝动脉灌注指数(HAPI).根据Edmondson-Steiner分级法行病理分级.不同分级肝细胞肝癌各灌注参数值相比采用单因素方差分析或非参数检验分析.采用Spearman等级相关的分析方法 对不同分化程度肝细胞肝癌的各灌注参数值、肿瘤微血管密度以及病理分级的相关性进行分析.结果 56例患者中,高分化肝癌15例,中分化肝癌29例,低分化肝癌12例.MVD值分别为48.61个/mm2、64.37个/mm2、86.31个/mm2.不同病理分级的肝细胞肝癌全肿瘤灌注测量值存在差异,低分化肝癌的HAP和HAPI最高,PVP最低,高分化肝癌的HAP和HAPI最低,PVP最高,中分化肝癌介于两者之间.不同病理分级肝细胞肝癌与肿瘤的MVD值呈正相关关系.高MVD计数组肝细胞肝癌的HAP、HAPI均高于低MVD计数组,差异有统计学意义.高MVD计数组肝细胞肝癌的PVP小于低MVD计数组,差异有统计学意义.结论 全肿瘤灌注测量值能够定量反映不同病理分级肝细胞肝癌的血流动力学及肿瘤血管状况,可作为活体无创性评估肿瘤病理分级及肿瘤血管生成的一种新的测量方法 .MVD与肝细胞肝癌的病理分级存在一定的相关性,可在全肿瘤灌注测量值的变化中得到反映.%Objective To evaluate the value of the total tumor perfusion by 320 row volume CT perfusion imaging in assessing the hemodynamic changes in the primary liver cancer patients,and to investigate value in evaluating the microvessel density and pathological grade.Methods 56 patients with primary liver cancer were prospectively selected to perform 320 row volume CT perfusion imaging.The parameters of the total tumor perfusion were calculated,including hepatic artery perfusion(HAP),portal vein perfusion(PVP)and hepatic perfusion index(HAPI).The pathological grade of the tissues were judged in specimens according to Edmondson-Steiner grading system.One-way ANOVA or Wilcoxon-Mann-Whitney test was performed to compare CT perfusion parameters of pathological grade of the tissues.Spearman rank correlation analysis was performed to compare the correlation among CT perfusion parameters,MVD,and pathological grade.Results Of the 56 cases,15 were well-differentiated HCC,29 moderate,and 12 low.MVD of well-,mid-,and low-differentiated HCC were 48.61/mm2,64.37/mm2,and 86.31/mm2,respectively.There was a significant difference among the perfusion of the different pathological grade of the tumor tissue.The results showed that low-differentiated HCC had highest HAP and HAPI and lowest PVP,and the well-differentiated HCC had lowest HAP and HAPI and highest PVP,while the mid-differentiated HCC was between well-differentiated HCC and the low-differentiated HCC.The expression of MVD were positively correlated with CT perfusion parameters of pathological grade of the tissues.There was a significant difference in the parameters between the high and low MVD groups.The results showed that the high MVD group had highest HAP and HAPI and lowest PVP compared with the low MVD group.Conclusion The total tumor perfusion by 320row volume CT perfusion imaging can quantitatively reflect the hemodynamical change of the lesions and the microvessel density.It may become a new way to evaluate noninvasively tumor's malignant degree and angiogenesis in vivo.The expressions of MVD in tissues are correlated with tumor pathological grade and total tumor perfusion parameters,which may be reflected to some degree by the tumor CT perfusion parameters.