CAJ | 학술논문

目的利用MR多回波R2*技术评估肝细胞癌(HCC)血氧水平,探讨其与临床、病理特征之间的关系.方法 2007年1月至2009年12月在山东大学齐鲁医院行手术切除、并经病理证实的肝细胞癌病例46例(46个病灶),手术前行MR多回波R2*扫描.在R2*图和T2*图上测量HCC、肝实质、脾及脊柱旁骨骼肌的T2*和R2*值,并计算该值的HCC/肝、HCC/脾及HCC/肌比值.临床资料记录患者的甲胎蛋白(AFP)水平、病灶大小、病理分级、有无包膜、肝硬化、腹水、门静脉癌栓及周围子灶等情况.将HCC的T2*、R2*值及其相关参数与以上临床、病理特征进行对照分析.结果 HCC的R2*值<肝和脾T2*值则相反(P<0.05).在AFP阳性和阴性组,HCC/肌R2*比值分别为0.81±0.26、1.23±0.39,差异有统计学意义(P=0.047,t=2.248);在有、无包膜组,HCC/肌R2*比值分别为0.83±0.24、1.23±0.43,差异有统计学意义(P=0.046,t=2.257);在有、无肝硬化组,HCC/脾R2*比值分别为1.01±0.58、0.53±0.17,HCC/脾T2*比值分别为1.42±0.92、2.64±1.15,差异均有统计学意义(P分别为0.035、0.036,t为2.247、2.230).在有、无周围子灶组,HCC/肌T2*比值为1.18±0.47、2.24±1.71(P=0.048,t=2.115),在有、无门静脉癌栓组,T2*值分别为(27.24±11.90)ms,(46.70±38.40)ms(P=0.049,t=2.046),差异均有统计学意义.但各测量值在Edmondson分级、有无腹水之间差异无统计学意义(P>0.05),与病灶大小也未见相关性(P>0.05).结论磁共振血氧水平参数R2*、T2*相关测量值与HCC的临床、病理特征具有一定的关系,HCC血氧水平受多种因素的影响.
목적 이용MR다회파R2*기술평고간세포암(HCC)혈양수평,탐토기여림상、병리특정지간적관계.방법 2007년1월지2009년12월재산동대학제로의원행수술절제、병경병리증실적간세포암병례46례(46개병조),수술전행MR다회파R2*소묘.재R2*도화T2*도상측량HCC、간실질、비급척주방골격기적T2*화R2*치,병계산해치적HCC/간、HCC/비급HCC/기비치.림상자료기록환자적갑태단백(AFP)수평、병조대소、병리분급、유무포막、간경화、복수、문정맥암전급주위자조등정황.장HCC적T2*、R2*치급기상관삼수여이상림상、병리특정진행대조분석.결과 HCC적R2*치<간화비T2*치칙상반(P<0.05).재AFP양성화음성조,HCC/기R2*비치분별위0.81±0.26、1.23±0.39,차이유통계학의의(P=0.047,t=2.248);재유、무포막조,HCC/기R2*비치분별위0.83±0.24、1.23±0.43,차이유통계학의의(P=0.046,t=2.257);재유、무간경화조,HCC/비R2*비치분별위1.01±0.58、0.53±0.17,HCC/비T2*비치분별위1.42±0.92、2.64±1.15,차이균유통계학의의(P분별위0.035、0.036,t위2.247、2.230).재유、무주위자조조,HCC/기T2*비치위1.18±0.47、2.24±1.71(P=0.048,t=2.115),재유、무문정맥암전조,T2*치분별위(27.24±11.90)ms,(46.70±38.40)ms(P=0.049,t=2.046),차이균유통계학의의.단각측량치재Edmondson분급、유무복수지간차이무통계학의의(P>0.05),여병조대소야미견상관성(P>0.05).결론 자공진혈양수평삼수R2*、T2*상관측량치여HCC적림상、병리특정구유일정적관계,HCC혈양수평수다충인소적영향.
Objective To probe the relationship of clinical and pathological features of hepatocellular carcinoma ( HCC) with the blood oxygen level by the technique of noninvasive magnetic resonance multi-echo R2 * . Methods Multi-echo R2 * sequence was carried out pre-operatively in a total of 46 patients with pathologically proved HCC. The T2 * and R2 * values of HCC, liver, spleen and paraspinous muscle on T2 * and R2 * maps and the ratios of HCC to liver ( H/L), spleen ( H/S) and muscle ( H/M) were calculated. Different groups were defined according to such clinical parameters as the serum AFP level, lesion dimension, Edmondson's grade, ascites, capsula, liver cirrhosis, intrahepatic daughter foci or tumor-emboli in portal vein respectively. The differences in T2 * and R2 * values and the ratios between different groups were analyzed. Results In contrast with T2 * value, the R2 * value of HCC was less than that of liver or spleen (P < 0.05). Difference in R2 * ratio of H/M (0. 81 ± 0. 26 vs 1. 23 ± 0. 39) was found between positive and negative groups of AFP (P = 0. 047, t = 2. 248 ). And so was the same difference (0. 83 ±0. 24 vs 1. 23 ±0. 43) between the lesions with or without capsula (P =0. 046, t = 2. 257). The R2 * ratio of H/S in hepatic cirrhosis group (1. 01 ±0. 58) was higher than that in non- cirrhosis one ( 0. 53 ± 0. 17) (P = 0. 035, t = 2. 247) whereas the T2 * ratio of H/S was reversed (1.42 ± 0. 92 vs 2. 64 ± 1. 15) (P =0. 036, 1=2. 230). The differences in T2 * ratio of H/M in the group with or without intrahepatic daughter foci (1. 18 ± 0. 47 vs 2. 24 ± 1. 71 ) ( P = 0. 048, t = 2. 115 ) , and in T2 * value in the group with or without tumor-emboli in portal vein (27. 24 ± 11. 90 ms vs 46. 70 ±38. 40 ms) (P =0.049, t =2.046) were shown to be significant However, no differences in MR parameters between other groups were observed (P>0. 05). Conclusion The blood oxygen level parameters, R2 * and T2 * values and the ratios are related to some clinical and pathological features of HCC. And the blood oxygen level is affected by multiple factors.