多模态影像学对肝细胞肝癌微血管侵犯诊断的研究进展

肝细胞肝癌居高不下的发病率及致死率引起广泛关注,而微血管侵犯是导致其术后复发转移、预后不良的危险因素。随着影像学技术的发展,术前应用影像学方法诊断肝细胞肝癌微血管侵犯成为现代放射医学亟待解决的问题。本文就多模态影像学对肝细胞肝癌微血管侵犯的诊断研究进展进行综述。     

全频超声乳化吸引刀切除肝细胞肝癌疗效观察

目的：观察全频超声乳化吸引刀（CUSA）切除原发性肝细胞肝癌的疗效。方法：选择原发性肝细胞肝癌患者54例,随机分为CUSA组（观察组）和常规钳夹组（对照组）各27例。观察比较两组术中情况、术后第7天肝功能水平、术后情况和术后并发症发生情况。结果：观察组术中出血量、输注浓缩红细胞数量,术后第7天ALT、AST和TB水平,术后引流量,拔管时间和平均住院时间与对照组比较,差异显著或非常显著（P〈0.05,P〈0.01）;手术时间、术后第7天ALB、PT水平与对照组比较,差异不显著（P〉0.05）;观察组无需阻断肝门血流,并发症发生率低。结论：CUSA切除原发性肝细胞肝癌可避免肝门血流阻断及缝合肝断面,术中出血量少,肝功能损害程度轻及并发症发生率低。     

功能MRI评价肝癌微创治疗疗效的研究进展

原发性肝细胞癌是最常见的恶性肿瘤之一。目前经导管肝动脉化学栓塞(TACE)、射频消融术(RFA)及高能聚焦超声(HIFU)等非手术微创治疗已成为外科手术之外治疗肝癌的首选方法。但由于治疗方法的局限性,术后常出现肿瘤病灶的残存或复发,因此准确评价术后疗效非常重要。近年扩散加权成像(DWI)、灌注成像(PWI)、磁共振波谱(MRS)在对肝癌的早期诊断及术后评价中发挥了重要作用。     

肝细胞肝癌TACE术后血管改变研究进展

肝细胞肝癌死亡率很高,但多数病人在确诊时往往处于中晚期而丧失手术机会,许多研究报道经导管动脉化疗栓塞（TACE）治疗手术不可切除肝癌具有较好疗效,推荐TACE作为巴塞罗那临床肝癌分期（BCLC 分期）B级肝细胞肝癌病人的标准治疗方案。但TACE难以完全栓塞肿瘤血供,TACE术后血流动力学改变和血管新生可以使肿瘤复发和转移。就肝细胞肝癌TACE术后血管改变特征、机制、诊疗方法以及该研究领域的新进展进行综述。     

原发性肝癌破裂出血手术切除治疗的预后分析

目的:分析原发性肝细胞肝癌破裂出血手术治疗的临床特点以及影响其预后的相关因素。方法:回顾性分析新疆医科大学第一附属医院自2000年1月至2010年12月诊断肝细胞性肝癌破裂出血并行手术切除治疗的26例患者临床资料特点及随访结果。结果:肝癌破裂出血急诊手术止血并切除肿瘤26例,术后1、3、5年生存率分别为80.0%、34.0%、13.0%。平均生存时间22.63±18.73月。结论:术前精确评估、避免输血和术后给予化疗栓塞是改善原发性肝癌破裂出血手术切除治疗后预后的有效措施。     

CT和MR新技术在肝癌TACE术后评估中的研究进展

肝细胞癌(HCC)是最常见的恶性肿瘤之一。TACE治疗被推荐为巴塞罗那临床分期系统(BCLC)中B期肝癌患者首选的治疗方法,合理评估TACE术后疗效有助于指导患者后续治疗,CT能谱成像和低剂量CT灌注成像是目前CT评价肝癌TACE术后疗效的新方向;弥散加权成像、灌注成像、磁共振波谱成像、普美显增强扫描、T_1 mapping成像等技术成为MR评估肝癌TACE疗效的研究热点。     

在MR普美显增强下原发性肝癌的LI-RADS分型和预后

正目的 (a)评价各型肝脏影像报告和数据系统(LIRADS)原发性肝癌术后的预后意义;(b)确定2017版LIRADS在MR普美显增强中区分肝细胞肝癌(HCC)、肝内胆     

经化疗栓塞治疗后肝细胞癌患者血清血管内皮生长因子与影像学特征的关系

目的　评估经导管化疗栓塞 (TACE)前后肝细胞癌患者血清血管内皮生长因子 (VEGF)水平变化及其与影像学的关系。方法　前瞻性对 30例肝细胞癌患者分别于第 1次TACE术前 1d、术后 3～ 4d及 2 8～ 30d测量血清VEGF水平。采用酶联免疫夹心法 (ELISA)定量测定血清VEGF水平。TACE术后 6个月CT及DSA评估患者肝癌转移发生情况。结果　在碘油分布不均匀及门静脉癌栓组中 ,术后血清VEGF水平与术前比较增高 (P <0 .0 5 )。转移性肝癌组患者术前的血清VEGF为 (2 11.0 6± 112 .11) pg/ml,显著高于非转移性肝癌组患者 (135 .79± 4 9.82 )pg/ml(P <0 .0 5 )。 结论　综合评价VEGF水平与影像学表现能较好的了解患者的预后。     

静脉酮体比值对肝癌患者肝动脉化疗栓塞治疗预后评估价值

目的探讨静脉酮体比值对肝细胞肝癌患者行导管肝动脉化疗栓塞(TACE)预后的评估价值。方法选取自2015年2月至2018年12月西南医科大学附属第一医院收治的行TACE治疗的156例HCC患者为研究对象。比较患者治疗前、后静脉酮体水平及其他临床病理参数;采用Logisitc回归分析及生存分析确定静脉酮体比值对经肝细胞肝癌患者行TACE预后的评估价值。结果患者治疗前、后静脉酮体比值与乙肝、肝硬化、肿瘤大小、门静脉癌栓及肿瘤复发密切相关(P<0.05)。治疗前、后静脉酮体比值>1.36是影响肝细胞肝癌患者行TACE术后预后的独立危险因素(P<0.05)。治疗前、后静脉酮体比值>1.36患者TACE术后存活率低于治疗前、后静脉酮体比值≤1.36患者(P<0.05)。结论 TACE治疗前、后静脉酮体比值是肝细胞肝癌患者预后独立的预测因素,治疗前、后静脉酮体比值>1.36往往提示该类患者行TACE治疗的预后较差。     

评价不可切除的肝细胞癌经动脉化疗栓塞后的长期毒副作用——单中心研究

目的评价肝细胞癌(HCC)病人经动脉化疗栓塞治疗(TACE)后6个月及1a的毒副作用。病例均进行规范化肿瘤治疗,可以与全身化疗的肝癌病人比较。材料及方法 本     

Sonographic diagnosis in primary cancer of the liver

The sonographic findings and their contribution to differential diagnosis and tumor staging are described in 34 patients with hepatocellular carcinoma and in 12 cases of cholangiocellular carcinoma. In most cases of hepatocellular carcinoma the liver was diffusely involved at presentation, whilst in cholangiocarcinoma tumor growth was usually limited to a single lobe. Over 60% of the hepatocellular carcinomas were predominantly echogenic. The cholangiocarcinomas all presented with a highly echogenic tumor in combination with uni- or bilaterally dilated intrahepatic bile ducts. In 20 patients estimation of liver size by the ultrasound-measurement of liver span in the right midclavicular line is compared with ultrasound-measured liver volume and its value in assessing response to therapy. Volume changes in response to therapy were demonstrated in five patients with hepatocellular carcinoma. In alpha-fetoprotein positive tumors they corresponded with changes in alpha-fetoprotein levels.     

64层螺旋CT血管成像对TACE治疗原发性肝癌的临床价值

目的:探讨64层螺旋CT血管成像对于肝癌(HCC)供血动脉的显示价值。方法:100例HCC患者在肝动脉化疗栓塞术(TACE)前后行MSCT扫描和血管成像。结果:100例患者的HCC供血血管被充分显示;TACE治疗效果与HCC供血动脉有密切关系,规则性供血类型与变异性血管类型差异有统计学意义(P=0.034)。结论:64层螺旋CT血管成像是一种评价HCC供血动脉的重要方法,为术式的选择及预后提供了重要信息。     

肝癌组织中骨桥蛋白的表达与临床病理因素的相关性研究

目的探讨骨桥蛋白(OPN)在肝癌组织中的表达与临床病理因素的关系。方法应用免疫组化法对70例肝癌组织、15例肝硬化组织和10例正常肝组织检测OPN的表达,并分析OPN的表达与临床病理因素之间的关系。结果 OPN在肝癌组织中的表达显著高于肝硬化组织及正常肝组织(P<0.01),而肝硬化组织与正常肝组织无明显差异(P>0.05);且OPN在肝癌组织中的高表达与肿瘤包膜不完整(P=0.044)及早期转移、复发(P=0.003)显著相关,而与其他临床病理因素无显著相关性。结论 OPN在肝癌组织中显著高表达,且与肿瘤包膜完整性、早期复发、转移相关。     

Fibrolamellar carcinoma of the liver: radiologic-pathologic correlation.

Fibrolamellar carcinoma is a malignant hepatocellular tumor with distinct clinical and pathologic differences from hepatocellular carcinoma. It differs from hepatocellular carcinoma in demographics, condition of the affected liver, tumor markers, and prognosis. Fibrolamellar carcinoma characteristically manifests as a large hepatic mass in adolescents or young adults (without gender predominance). Cirrhosis; elevated alpha-fetoprotein levels; and typical risk factors for hepatocellular carcinoma such as viral hepatitis, alcohol abuse, and metabolic disease are typically absent. Fibrolamellar carcinoma is characterized pathologically by cords of tumor cells surrounded by abundant collagenous fibrous tissue arranged in a parallel or lamellar distribution. Fibrotic lamellae often coalesce to form a central scar. Fibrolamellar carcinoma characteristically appears on radiologic images as a lobulated heterogeneous mass with a central scar in an otherwise normal liver. Radiologic evidence of cirrhosis, vascular invasion, or multifocal disease--findings typical of hepatocellular carcinoma--is uncommon in fibrolamellar carcinoma. Imaging features of fibrolamellar carcinoma overlap with those of other scar-producing lesions including focal nodular hyperplasia (FNH), hepatocellular adenoma and carcinoma, hemangioma, metastases, and cholangiocarcinoma. FNH, in particular, may simulate fibrolamellar carcinoma, since both have similar demographic and clinical characteristics. Because some believe that radiologic diagnosis of FNH is possible, it is important to understand the imaging appearance of fibrolamellar carcinoma to avoid misdiagnosing this malignant tumor as a FNH.     

Mixed-ligand complexes of yttrium-90 dialkyldithiocarbamates with 1,10-phenanthroline as a possible agent for therapy of hepatocellular carcinoma

Yttrium-90 is a radioelement which has found wide use in targeted radionuclide therapy because of its attractive physical and chemical properties. Radioembolisation of hepatocellular carcinoma with radiolabelled Lipiodol is a method of choice. We have synthesised a series of alkyldithiocarbamate yttrium complexes, easily extracted into Lipiodol due to their high lipophilicity. Among the prepared series, a new radioconjugate, which is stable over an extended period of time, has been prepared, and could represent a potential treatment procedure for hepatocellular carcinoma.     

Tc-99m MIBI SPECT is useful for noninvasively predicting the presence of MDR1 gene-encoded P-glycoprotein in patients with hepatocellular carcinoma.

PURPOSE: Resistance to chemotherapeutic drugs continues to be one of the major unsolved problems in the treatment of cancer. Multidrug resistance is defined as the ability of cells exposed to a single drug to develop resistance to a broad range of structurally and functionally unrelated drugs as a result of enhanced outward transport of drugs mediated by P-glycoprotein that is encoded by multidrug resistance genes. Recent evidence has shown that Tc-99m MIBI is a suitable transport substrate for P-glycoprotein. A potential advantage of Tc-99m MIBI SPECT is its superiority to diagnose noninvasively the presence of P-glycoprotein overexpression in vivo. In this study, the authors determined the association of enhanced MIBI efflux in Tc-99m MIBI SPECT with overexpression of P-glycoprotein in hepatocellular carcinoma. MATERIALS AND METHODS: Thirty-five patients with hepatocellular carcinoma were enrolled in the study. Tc-99m MIBI SPECT was performed 10 minutes after intravenous injection of 20 mCi Tc-99m MIBI. All patients had liver biopsy or surgery within 1 week of MIBI imaging. Immunohistochemical study of the biopsy or resected hepatocellular carcinoma specimens was performed using the avidin-biotin-peroxidase technique with monoclonal antibody JSB-1 directed against P-glycoprotein. RESULTS: On Tc-99m MIBI SPECT, 30 of 35 (85.7%) patients with hepatocellular carcinoma had no Tc-99m MIBI uptake in tumor lesions, whereas five patients with hepatocellular carcinoma had Tc-99m MIBI uptake in tumor lesions. P-glycoprotein expression was observed in tumor tissues of all the patients without Tc-99m MIBI uptake, whereas among the five patients with Tc-99m MIBI uptake, no P-glycoprotein expression was seen in tumor lesions (P < 0.015). CONCLUSION: Tc-99m MIBI SPECT is useful for noninvasively predicting the presence of MDR1 gene-encoded P-glycoprotein in patients with hepatocellular carcinoma.     

DWI在肝癌TACE后疗效评价的研究进展

肝动脉化疗栓塞治疗是不可切除性肝癌的重要治疗方法,其疗效是制定临床治疗计划的重要参考,本文就利用磁共振弥散加权成像进行评价的研究进展展开综述.     

Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review

Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.     

Duplex pulsed Doppler sonography in the differential diagnosis of hepatocellular carcinoma and other common hepatic tumours.

180 previously untreated consecutive patients with liver tumours (308 lesions), including 104 hepatocellular carcinomas (148 lesions), 43 metastases (116 lesions) and 33 haemangiomas (44 lesions), were studied to determine the value of duplex sonography in the differentiation of hepatocellular carcinoma from other tumours. For lesions measuring less than or equal to 5 cm in diameter, hepatocellular carcinoma demonstrated the highest rate and haemangioma demonstrated the lowest rate of Doppler signals from within the lesions. To differentiate malignancy from haemangioma, the presence or absence of Doppler signals from these lesions were used as criteria. The specificity and positive predictive value were very high (100%, 100%), but the sensitivity, negative predictive value and accuracy were low (61.5%, 48.3%, 71.7%, respectively). With one exception, all lesions measuring less than 3 cm in diameter with detectable Doppler signals were hepatocellular carcinoma. Using these results it is possible to differentiate hepatocellular carcinoma from metastases and haemangioma with high sensitivity, specificity, positive and negative predictive value, and accuracy (80.8%, 96.4%, 95.5%, 84.4%, 88.9%, respectively, for metastases; 80.8%, 100%. 100%, 81.5%, 89.6%, respectively, for haemangioma). We conclude that Doppler signals from within a lesion in combination with its size can aid differentiation of hepatocellular carcinoma from two other kinds of common hepatic tumour.     

原发性肾上腺淋巴瘤合并肝细胞癌全身18F-FDG PET/CT显像1例

笔者报道了1例原发性肾上腺淋巴瘤（PAL）合并肝细胞癌患者全身18F-氟脱氧葡萄糖（FDG） PET/CT 显像,PAL在临床上相对少见,特别是遇到合并其他恶性肿瘤的患者时容易误诊为恶性肿瘤转移。笔者主要分析了PAL合并肝细胞癌全身18F-FDG PET/CT 显像的特点并进行文献复习,为其诊断提供更多参考。