CAJ | 학술논문

目的研究肝细胞癌(HCC)血管生成及其成熟度与磁共振成像(MRI)去氧血红蛋白参数T2~*、R2~*值及病灶/肌肉T2~*、R2~*比值关系.方法选取行手术切除并经病理证实的肝细胞癌患者31例,术前行MRI扫描并计算T2~*、R2~*值及病灶/肌肉T2~*、R2~*比值;术后在与MRI感兴趣区相同位置取材,采用免疫组织化学技术检测血管内皮生长因子(VEGF)及其受体Flk-1表达情况和增殖细胞核抗原(PCNA)指数,病理图像自动分析系统统计微血管和成熟血管数目、平均面积、总面积、周长、直径、异型指数、血管间距,及动脉数、静脉数、血管成熟指数和平均灌注分数等.将T2~*、R2~*值及病灶/肌肉T2~*、R2~*比值与各个血管参数进行对照分析.结果病灶边缘和中心的T2~*、R2~*值及其病址/肌肉T2~*、R2~*比值与肝脏间差异有统计学意义(P<0.05),但在病灶边缘与中心间及不同病理分级间差异均无统计学意义(P>0.05).VEGF阳性组T2~*值及其病灶/肌肉比值明显低于阴性组(P<0.05).HCC的T2~*值与微血管数目呈负相关(P=0.047,r=-0.639),与平均灌注分数呈正相关(P=0.040,r=0.655);其病灶/肌肉比值也与平均灌注分数呈正相关(P=0.048,r=0.640).R2~*值分别与微血管平均面积(P=0.028,r=0.688)、总面积(P=0.021,r=0.712)和周长(P=0.037,r=0.663)呈正相关,与平均灌注分数呈负相关(P=0.024,r=-0.702);其病灶/肌肉比值分别与微血管平均面积(P=0.043,r=0.647)和周长(P=0.026, r=0.694)呈正相关.结论 HCC新生血管形态异常导致的去氧血红蛋白变化可能影响T2~*、R2~*值.
목적 연구간세포암(HCC)혈관생성급기성숙도여자공진성상(MRI)거양혈홍단백삼수T2~*、R2~*치급병조/기육T2~*、R2~*비치관계.방법 선취행수술절제병경병리증실적간세포암환자31례,술전행MRI소묘병계산T2~*、R2~*치급병조/기육T2~*、R2~*비치;술후재여MRI감흥취구상동위치취재,채용면역조직화학기술검측혈관내피생장인자(VEGF)급기수체Flk-1표체정황화증식세포핵항원(PCNA)지수,병리도상자동분석계통통계미혈관화성숙혈관수목、평균면적、총면적、주장、직경、이형지수、혈관간거,급동맥수、정맥수、혈관성숙지수화평균관주분수등.장T2~*、R2~*치급병조/기육T2~*、R2~*비치여각개혈관삼수진행대조분석.결과 병조변연화중심적T2~*、R2~*치급기병지/기육T2~*、R2~*비치여간장간차이유통계학의의(P<0.05),단재병조변연여중심간급불동병리분급간차이균무통계학의의(P>0.05).VEGF양성조T2~*치급기병조/기육비치명현저우음성조(P<0.05).HCC적T2~*치여미혈관수목정부상관(P=0.047,r=-0.639),여평균관주분수정정상관(P=0.040,r=0.655);기병조/기육비치야여평균관주분수정정상관(P=0.048,r=0.640).R2~*치분별여미혈관평균면적(P=0.028,r=0.688)、총면적(P=0.021,r=0.712)화주장(P=0.037,r=0.663)정정상관,여평균관주분수정부상관(P=0.024,r=-0.702);기병조/기육비치분별여미혈관평균면적(P=0.043,r=0.647)화주장(P=0.026, r=0.694)정정상관.결론 HCC신생혈관형태이상도치적거양혈홍단백변화가능영향T2~*、R2~*치.
Objective To explore the angiogenesis and its maturation of hepatocellular carcinoma (HCC) and its correlation with deoxyhemoglobin parameters R2 ~* and T2~* values and the lesion/muscle R2~*, T2~* ratio by using noninvasive magnetic resonance imaging (MRI). Methods T2~*, R2~* values and the lesion/muscle R2~*, T2~* ratio in tumor periphery and center were calculated via series T2~* images in a total of 31 patients with surgically and pathologically confirmed HCC. After surgery, all sections were obtained from the specimen periphery in accordance with the MR analyzed areas. Continuous slices of each lesion were stained with hematoxylin-eosin (HE), and immunohistochemical staining was performed in vascular endothelial growth factor (VEGF), Flk-1, proliferating cell nuclear antigen (PCNA), CD34, and alpha smooth muscle actin (SMA). The expressions of VEGF, Flk-1, and PCNA index (PI) were evaluated. According to CD34 and SMA, some vascular parameters, including number, mean vessel area, total vessel area, circumference, diameter, distance between adjacent vessels, and variety index of microvessel and mature vessel, were calculated with a computed analysis system. The amounts of arterioles and veinlets, mature vessel index, and mean perfused fraction (mPF) were also recorded. All vessel parameters were compared with the calculated values of MRI. Results R2~* value or lesion/muscle R2~* ratio decreased and T2~* value or the lesion/muscle T2~* ratio increased in HCC when compared with hepatic parenchyma (P<0. 05) ; however, those values between lesion periphery and center and among different pathological grades were not significantly different (P > 0. 05). T2~* value and the lesion/muscle T2~* ratio significantly decreased when the expression of VEGF was positive (P < 0. 05). T2~* value was negatively correlated with microvessel amount (P = 0. 047, r = - 0. 639), while T2~* value and the lesion/muscle T2~* ratio were positively correlated with mPF (P = 0. 040, r = 0. 655 ; P = 0.048, r= 0.640, respectively). R2~* value was also positively correlated with mean area (P =0.028, r = 0. 688), total area (P = 0. 021, r = 0.712) or circumference (P = 0. 037, r = 0. 663) of microvessel, and negatively correlated with mPF (P = 0. 024, r = - 0. 702). Meanwhile, the lesion/muscle R2~* ratio was positively correlated with mean area (P = 0. 043, r = 0. 647) and circumference (P = 0. 026, r = 0. 694) of mi-crovessels. Conclusion R2~* or T2~* value may be influenced by the variation of deoxyhemoglobin caused by the heterogeneity of angiogenesis.