CAJ | 학술논문

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24～48 h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)×10-3mm2/s,坏死区ADC值为(1.58±0.18)×10-3mm2/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.
목적 탐토간세포암(간암)경도관동맥화료전새(TACE)후자공진확산가권성상(MRDWI)표현적병리기출.방법 15례경TACE후행Ⅱ기절제적간암환자,술전24～48 h진행MRDWI,대표본진행대체병리、HE염색급감성성섬유세포생장인자(bFGF)면역조화염색관찰.결과 15례환자중,12례존활류구위고신호,3례위등신호.8례응고성배사구위저신호,6례위등신호,1례정고신호.종류존활구표관확산계수(ADC)치위(1.42±0.16)×10-3mm2/s,배사구ADC치위(1.58±0.18)×10-3mm2/s,량자차이유통계학의의(P<0.05).TACE술후、Ⅱ기수술절제전적ADC치여간암적Edmondson분급、배사정도유관(균P<0.05).15례환자중,10례종류존활구bFGF단백강표체,5례약표체,간암조직bFGF단백표체여기ADC치정부상관(r=-0.552,P=0.033).결론 간암TACE후,MRDWI능교호지감별존활여배사종류조직.
Objective To explore the pathological basis of diffnsion-weighted imaging (DWI) findings in hepatocellular carcinoma (HCC) after transcatbeter 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)×10-3mm2/s and ( 1.58±0.18 )×10-3 mm2/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 (X2= 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.