摘要
目的:对不同病理分级的肝细胞肝癌(HCC)病人术前行CT多期增强扫描,将CT相对强化指数、形态学特征与肿瘤的病理分级做对比分析,探讨CT相对强化指数在 HCC术前分级中的应用价值.方法:收集 2020 年 1 月—2023 年 11 月于广西桂平市中医医院就诊的 75 例HCC病人,男 40 例,女 35 例,所有病人均经外科手术病理证实为HCC.扫描采用 128 排螺旋CT扫描设备(GE Revolution),包括常规肝脏平扫,肝脏动脉期、门静脉期、延迟期增强扫描.观察肿瘤的范围、内径、假包膜、囊变、出血、癌栓、侵犯肝包膜和远处转移等形态学征象.测量CT增强扫描各期的相对强化指数.采用国际上常用的Edmondson-Steiner四级(Ⅰ～Ⅳ)分级方法,将75例肿瘤分为两组,其中Ⅰ、Ⅱ级为低级别组,Ⅲ、Ⅳ级为高级别组.比较两组HCC的CT影像表现差异.结果:75例HCC为肝内单发肿瘤,低级别组37例,高级别组38例.两组间肿瘤囊变、出血的差异无统计学意义(P＞0.05).低级别组和高级别组肿瘤的平均内径分别为(5.08±3.22)cm和(8.47±3.75)cm,随着病理级别的上升,肿瘤的内径有所增加,两组间差异有统计学意义(P＜0.05).两组肿瘤的范围、假包膜、癌栓、转移、侵犯肝包膜差异有统计学意义(P＜0.05).低、高级别两组之间的门静脉期相对强化指数、延迟期相对强化指数差异有统计学意义(P＜0.05),两组间动脉期相对强化指数的差异无统计学意义(P＞0.05).门静脉期相对强化指数和延迟期相对强化指数鉴别低、高级别HCC的受试者工作特征曲线下面积分别为 0.855、0.817,门静脉期相对强化指数的曲线下面积优于延迟期的相对强化指数.结论:CT相对强化指数结合形态学特征能在术前较好地评估HCC的病理分级,对临床治疗方案选择及判断预后有较好的指导价值.
Abstract
Objective Patients with different differentiated hepatocellular carcinoma(HCC)underwent CT.The CT relative enhancement index,morphological characteristics and pathological grade of tumor were analyzed,to explore the value of CT in preoperative grading of HCC.Methods 75 HCC patients were collected,including 40 males and 35 females,who were treated at Guiping Traditional Chinese Medicine Hospital in Guangxi from January 2020 to November 2023.All patients were confirmed to have HCC by surgical pathology.Scanning was performed with a 128-row spiral CT scanning device(GE revolution).The scanning protocol included routine plain abdominal scan and enhanced liver arterial,portal,and delayed scans.Morphological signs of tumor location,maximum diameter,pseudocapsule,cystic changes,hemorrhage,cancer thrombus,invasion of liver capsule and distant metastasis were observed.The relative reinforcement index during arterial period,portal period,and delay period were measured.Using the grade method of the Edmondson-Steiner(Ⅰ-Ⅳ)internationally used,75 tumors were divided into two groups.Among them,the I-Ⅱ grade is the lower level group,and the Ⅲ-Ⅳ grade is higher level group,comparing the differences in CT imaging findings between the two tumor groups.Results All 75 HCC were single lesions,including 37 in the lower group and 38 in the higher group.There was no significant difference in tumor cyst and hemorrhage between the two groups(P＞0.05).The average maximum diameter of lower and higher tumors were(5.08±3.22)cm and(8.47±3.75)cm,respectively.With the increase of pathological grade,the maximum diameter of the tumor increased.There were statistically significant difference between the two groups(P＜0.05).The location,pseudocapsule,carcinoma thrombus,metastasis,and liver capsule invasion were all statistically significant differences between the two tumor groups(P＜0.05).There were significant difference in relative reinforcement index of portal stage and delay period between the two groups(P＜0.05).There was no significant difference in the relative enhancement index of arterial stage between the two groups(P＞0.05).The receiver operating characteristic(ROC)curve analysis results of identifying low and high-grade HCC between portal phase and delay period were as follows:The area under the curve of ROC for both are 0.855 and 0.817,respectively.Portal phase relative enhancement index can better identify low and high-grade HCC.Conclusion Quantitative parameters obtained from the CT multistage enhanced scanning technique combined with morphological features contribute to the preoperative pathological grading of HCC.It has a good guiding value for clinical treatment plan selection and prognosis judgment.
维普
万方数据