肝细胞癌螺旋CT同层动态扫描表现与肿瘤血管生成的相关性

目的 探讨肝细胞癌螺旋CT同层动态扫描所获部分参数和形态学表现特征与肿瘤血管生成的相关性。方法 经病理证实的肝细胞癌26例、全肝平扫后选择靶平面行同层动态扫描和门脉期全肝扫描，评价癌灶形态表现特征、时间－密度曲线（T－DC）走势，并计算癌灶强化峰值（PV）和强化比值（CER）。组织切片经Ⅷ因子相关抗原（F8RA）和血管内皮生长因子（VEGF）免疫组化染色，分析癌组织微血管数（MVC）和癌细胞VEGF表达阳性率。将CT形态表现和所获部分参数与组织病理学改变进行比较研究。结果 癌灶PV7．9－75．2HU，CER3．8％－36．0％；MVC6－91，VEGF阳性率32％－78％。癌灶PV、CER与MVC呈显著正相关（r分别为0．508、0．423，P值分别＜0．01、0．05），癌灶PV、CER与VEGF阳性率无显著相关性（r分别炎0．256、0．347，P值均＞0．05）；肿瘤新生血管分布影响TDC走势，肿瘤血管是否丰富及其组织结构特点影响肿瘤强化特征。结论 根据肝细胞癌螺旋CT同层动态扫描部分参数及T－DC走势和增强大体形态表现，可推测癌组织MVC和肿瘤新生血管分布特征，并可反映肿瘤血管是否丰富及肿瘤组织结构特点。

Single-level dynamic spiral CT of hepatocellular carcinoma: correlation between imaging features and tumor angiogenesis

Objective To investigate the correlation of the enhancement imaging features of hepatocellular carcinoma (HCC) and relevant parameters revealed by single-level dynamic spiral CT scanning with tumor microvessel counting (MVC). Methods The study included 26 histopathologically proven HCC patients. Target-slice dynamic scanning and portal venous phase scanning were performed for all patients. The time-density curves were generated with measurement of relevant parameters including: peak value (PV) and contrast enhancement ratio (CER), and the gross enhancement morphology analyzed. Histopathological slides were carefully prepared for the standard F8RA and VEGF immunohistochemical staining and tumor microvessel counting and calculation of VEGF expression percentage of tumor cells. The enhancement imaging features of HCC lesions were correlatively studied with tumor MVC and VEGF expression. Results Peak value of HCC lesions were 7.9 to 75.2 HU, CER were 3.8% to 36.0%. MVC were 6 to 91, and the VEGF expression percentage were 32.1% to 78.3%. The PV and CER were significantly correlated with tumor tissue MVC (r=0.508 and 0.423, P<0.01 and 0.05 respectively). There were no correlations between PV and CER and VEGF expression percentage. Both the patterns of time-density curve and the gross enhancement morphology of HCC lesions were also correlated with tumor MVC, and reflected the distribution characteristics of tumor microvessels within HCC lesions. A close association was found between the likelihood of intrahepatic metastasis of HCC lesions with densely enhanced pseudocapsules and the presence of rich tumor microvessels within these pseudocapsules. Conclusion The parameters and the enhancement imaging features of HCC lesions on target-slice dynamic scanning are correlated with tumor MVC, and can reflect the distribution characteristics of tumor microvessels within HCC lesions. Dynamic spiral CT scanning is a valuable means to assess the angiogenic activity and tumor neovascularity in vivo for HCC patients.