磁共振弥散加权成像评估肝细胞癌组织学分级的价值

doi:10.6040/j.issn.1671-7554.0.2014.594

摘要/Abstract

摘要： 目的探讨弥散加权成像(DWI)评价肝细胞癌(HCC)组织学分级的价值。方法经手术切除且病理证实HCC患者27例,术前均行上腹部常规磁共振成像(MRI)及DWI检查,分析病灶的DWI信号强度、表观弥散系数(ADC)值与HCC组织学分级之间的关系。结果本组27例27个HCC病灶中,组织病理学诊断高分化HCC病灶6个、中分化HCC病灶10个、低分化HCC病灶11个。在DWI中,1例(3.7%)为等信号,9例(33.3%)为略高信号,17例(63%)为高信号。不同分化HCC信号强度之间差异无统计学意义(P=0.758)。低分化HCC的ADC值[(1.16±0.16)×10^-3mm²/s]明显小于高分化[(1.43±0.09)×10^-3mm²/s](P=0.004)和中分化 [(1.34±0.19)×10^-3mm²/s](P=0.023)。HCC的ADC值与组织学分级呈中等负相关(r=-0.566,P=0.002)。结论应用ADC值能区分低、中、高分化HCC,因而ADC值有助于术前预测HCC的组织学分级。另外,DWI信号强度对HCC的组织学分级价值不大。

关键词: 表观弥散系数, 组织学分级, 弥散加权成像, 肝细胞癌, 磁共振成像

Abstract: Objective To evaluate the significance of magnetic resonance diffusion-weighted imaging (DWI) in predicting the histological grading of hepatocellular carcinoma (HCC). Methods Data of 27 patients with 27 surgically removed HCC who underwent preoperative conventional MRI and DWI examinations were retrospectively reviewed. The relationship between visual signal intensity and apparent diffusion coefficient (ADC) with histological differentiation of HCC was analyzed. Results Histopathologically, the tumors were classified into well-differentiated (n=6), moderately-differentiated (n=10) and poorly-differentiated (n=11). On DWI, 1 of the 27 HCCs appeared isointense, 9 slightly hyperintense, and the remaining 17 tumors hyperintense to the surrounding liver. Statistical analysis revealed no significant difference between visual signal intensity and histopathologic grade (P=0.758). The mean ADC value of the poorly-differentiated HCCs[(1.16±0.16)×10^-3mm²/s] was significantly lower than that of the well-differentiated HCCs[(1.43±0.09)×10^-3mm²/s] (P=0.004) and moderately-differentiated HCCs [(1.34±0.19)×10^-3mm²/s] (P=0.023). There was a significant correlation between the differentiation and the ADC value of the HCCs (r=-0.566, P=0.002). Conclusion DWI with ADC measurement of HCC may be a valuable imaging tool to noninvasively predict the differentiation of HCC. However, the histopathological grades of HCC are not correlated with the visualsignal intensity.

Key words: Magnetic resonance imaging, Diffusion-weighted imaging, Hepatocellular carcinoma, Histological grading, Apparent diffusion coefficient

中图分类号:

R445.2

郭卫华, 赵素红, 庞国栋, 邵广瑞. 磁共振弥散加权成像评估肝细胞癌组织学分级的价值[J]. 山东大学学报（医学版）, 2014, 52(12): 89-93.

GUO Weihua, ZHAO Suhong, PANG Guodong, SHAO Guangrui. Application value of diffusion-weighted MR imaging in estimating the histological grade of hepatocellular carcinoma[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(12): 89-93.

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