大鼠小肝癌病理特性及其与影像学诊断关系的实验研究

目的： 探讨小和微小肝癌的病理特点及其和ＭＲＩ、彩色多谱勒超声（ 简称彩超） 、肝动脉和门静脉造影诊断的关系。材料和方法： 应用大鼠肝癌模型进行ＭＲＩ、彩超和肝动脉与门静脉造影， 并与组织病理对照。结果： 大于５ｍ ｍ 的癌灶主要为肝动脉供血， 门静脉在瘤体周边参与供血， 细胞分化相对较差，３ － ５ ｍ ｍ 的癌灶有动脉与门脉双重供血， 细胞分化高， 小于３ｍ ｍ 的癌灶以门静脉供血为主， 细胞分化高。大于５ｍ ｍ 的癌灶检出率ＭＲＩ、ＨＡＡ 和彩超为１００ ％ ， 而ＨＰＡ 为７５ ％ ；３ ～５ ｍ ｍ 的癌灶检出率彩超和ＭＲＩ 为１００ ％ 和９５ ％ ， ＨＡＡ、ＨＰＡ 为７５ ％ 和８５ ％ ； ２ ～３ｍ ｍ 的癌灶检出率ＭＲＩ 较高 （７１ ．１５ ％ ） 、ＨＰＡ 和彩超为５３ ．８５ ％ 和５１ ．９２ ％ ， ＨＡＡ 为２６ ．９２ ％ ；小于２ ｍ ｍ 的癌灶检出率ＨＰＡ 较高为６０ ．７８ ％ ，余均低。结论：小和微小肝癌（ 小于５ ｍ ｍ ） 存在肝动脉和门静脉双重血供或以门静脉为主要血供是其病理特点，ＭＲＩ 在检查小肝癌尤其微小肝癌方面优于彩超。

Correlative Experimental Study of Pathology and Imaging Diagnosis of Small Hepatocellular Carcinoma

Purpose:To investigate the correlation among pathology and diagnosis of MRI,Doppuler US, hepatic arteriography and portovenography in small hepatocellular carcinomas.Materials and Methods:MRI,Color Doppler US,Hepatic arteriography and portovenography were performed in mice with hepatocellular carcinoma,and then undergone comparison with pathology.Results:The cells of carcinoma in 5mm diameter were mainly supplied by hepatic artery together with peripheral portal venous seeding and were usually in poor cell differentiation;the lesions bettween 3 to 5mm in diameter possessed both hepatic arterial and portal venous supplies often with high cell differentiation;those lesions less than 3mm in diameter were mainly supplied by portal veins with high cell differentiation.The detectabilities of MRI, Doppler US,HAA,HPA were 100%,100%,100%,75% respectively in lesions larger than 5mm;95%,100%,75%and 85%in lesions between 3 to 5mm;71.15%,51.92%,53.85%and 26.92% in lesions between 2 to 3mm.For lesions less than 2mm,the detectability by HPA was relatively high,others were fairly low.Conclusion:The blood supply of small or micro-hepatocellular carcinoma(<0.5mm)with both hepatic artery and portal veins or mainly by portal venis is the pathologic characteristics,MRI is more sensitive method for detection of small or micro-hepatocellular carcinoma than Doppler US.