原发性肝细胞癌微血管密度与其超声造影血流灌注量参数的相关性
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摘要
背景原发性肝细胞癌(hepatocellular carcinoma, HCC)在我国有着较高发病率和死亡率,对人们健康构成严重威胁. HCC是一种富血供恶性肝脏肿瘤,其发生、发展、侵袭以及转移有着明显血管依赖性.病理检查是评估HCC微血管生成状态的"金标准",但具有创伤性.超声造影能实时动态反映肿瘤组织的血流灌注过程,可反映肿瘤组织的微血管生成状态.运用超声造影评估HCC的微血管生成状态,对于临床制定治疗方案意义重大.目的运用超声造影分析HCC的血流灌注状态,并评估其微血管密度.方法选取在浙江省肿瘤医院行手术切除并经病理证实的68例HCC患者(共68个病灶)作为研究对象.所有患者于术前均行超声造影检查,通过时间-强度曲线测定病灶组织及病灶旁肝组织的峰值强度和曲线下面积,分析其与术后组织标本微血管密度的相关性.结果HCC病灶组织的峰值强度和曲线下面积明显高于病灶旁肝组织,差异有统计学意义(P<0.05); HCC病灶组织的微血管密度明显高于病灶旁肝组织,差异有统计学意义(P<0.05); HCC的峰值强度和曲线下面积均与微血管密度呈正相关(r=0.840, P<0.05; r=0.781,P <0.05).结论超声造影可定量评估HCC的血流灌注量,其血流灌注量参数与微血管密度相关性良好,可为临床无创性评估HCC微血管生成状态提供有价值的参考.
BACKGROUND Primary hepatocellular carcinoma(HCC) has a high incidence and mortality in China, posing a serious threat to people's health. HCC is a blood-rich malignant liver neoplasm, and its development, progression, invasion, and metastasis have obvious vascular dependence. Pathological examination is the golden standard for evaluating the microangiogenesis of HCC, but it is traumatic. Contrast-enhanced ultrasound candynamically monitor the blood perfusion process of tumor tissue in real time and thus assess the microangiogenesis in tumor tissue. It is of great significance to evaluate the microangiogenesis of HCC by contrast-enhanced ultrasound for evaluation of its clinical treatment.AIM To analyze the blood perfusion status of HCC by contrastenhanced ultrasound, and evaluate its correlation with microvessel density. METHODS Sixty-eight patients with HCC(68 lesions) who underwent surgical resection and were confirmed by pathology at Zhejiang Tumor Hospital were selected as subjects. All patients underwent contrast-enhanced ultrasound before operation. The peak intensity and the area under the curve were measured by the timeintensity curve, and the correlations between peak intensity, the area under the curve, and microvessel density were analyzed. RESULTS The peak intensity and the area under the curve were significantly higher in HCC than in tumor adjacent tissues(P < 0.05). The microvessel density of HCC was significantly higher than that of adjacent tissues(P < 0.05). The peak intensity and the area under the curve were positively correlated with microvessel density in HCC(r = 0.840, P < 0.05; r = 0.781, P < 0.05). CONCLUSION Contrast-enhanced ultrasound can quantitatively evaluate the blood perfusion of HCC. The correlation between the parameters of blood perfusion and microvessel density is good. Contrast-enhanced ultrasound can provide valuable information for noninvasive assessment of angiogenesis of HCC.
BACKGROUND Primary hepatocellular carcinoma(HCC) has a high incidence and mortality in China, posing a serious threat to people's health. HCC is a blood-rich malignant liver neoplasm, and its development, progression, invasion, and metastasis have obvious vascular dependence. Pathological examination is the golden standard for evaluating the microangiogenesis of HCC, but it is traumatic. Contrast-enhanced ultrasound candynamically monitor the blood perfusion process of tumor tissue in real time and thus assess the microangiogenesis in tumor tissue. It is of great significance to evaluate the microangiogenesis of HCC by contrast-enhanced ultrasound for evaluation of its clinical treatment.AIM To analyze the blood perfusion status of HCC by contrastenhanced ultrasound, and evaluate its correlation with microvessel density. METHODS Sixty-eight patients with HCC(68 lesions) who underwent surgical resection and were confirmed by pathology at Zhejiang Tumor Hospital were selected as subjects. All patients underwent contrast-enhanced ultrasound before operation. The peak intensity and the area under the curve were measured by the timeintensity curve, and the correlations between peak intensity, the area under the curve, and microvessel density were analyzed. RESULTS The peak intensity and the area under the curve were significantly higher in HCC than in tumor adjacent tissues(P < 0.05). The microvessel density of HCC was significantly higher than that of adjacent tissues(P < 0.05). The peak intensity and the area under the curve were positively correlated with microvessel density in HCC(r = 0.840, P < 0.05; r = 0.781, P < 0.05). CONCLUSION Contrast-enhanced ultrasound can quantitatively evaluate the blood perfusion of HCC. The correlation between the parameters of blood perfusion and microvessel density is good. Contrast-enhanced ultrasound can provide valuable information for noninvasive assessment of angiogenesis of HCC.
引文
1于兰芝,刘艳洁,王彦明.HBV感染与原发性肝细胞癌的关系及临床意义.癌症进展2018;16:328-330[DOI:10.11877/j.issn.1672-1535.2018.16.03.19]
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6 Leon SP,Folkerth RD,Black PM.Microvessel density is a prognostic indicator for patients with astroglial brain tumors.Cancer 1996;77:362-372[PMID:8625246 DOI:10.1002/(SICI)1097-0142(19960115)77:2<362:AID-CNCR20>3.0.CO;2-Z]
7 Rübenthaler J,Paprottka KJ,Hameister E,Hoffmann K,Joiko N,Reiser M,Rjosk-Dendorfer D,Clevert DA.Diagnostic accuracy of contrast-enhanced ultrasound(CEUS)in monitoring vascular complications in patients after liver transplantation-diagnostic performance compared with histopathological results.Clin Hemorheol Microcirc 2017;66:311-316[PMID:28527202 DOI:10.3233/CH-179105]
8 Gürtler VM,Rjosk-Dendorfer D,Reiser M,Clevert DA.Comparison of contrast-enhanced ultrasound and compression elastography in the follow-up after endovascular aortic aneurysm repair.Clin Hemorheol Microcirc 2014;57:175-183[PMID:24595129 DOI:10.3233/CH-141828]
9 Mori N,Mugikura S,Takahashi S,Ito K,Takasawa C,Li L,Miyashita M,Kasajima A,Mori Y,Ishida T,Kodama T,Takase K.Quantitative Analysis of Contrast-Enhanced Ultrasound Imaging in Invasive Breast Cancer:A Novel Technique to Obtain Histopathologic Information of Microvessel Density.Ultrasound Med Biol 2017;43:607-614[PMID:28041744 DOI:10.1016/j.ultrasmedbio.2016.11.009]
10陶一明,王志明.出血坏死表型肝细胞癌肿瘤微血管特征研究.中国普通外科杂志2016;25:985-990[DOI:10.3978/j.issn.1005-6947.2016.07.009]
2 Ozakyol A.Global Epidemiology of Hepatocellular Carcinoma(HCC Epidemiology).J Gastrointest Cancer 2017[PMID:28626852 DOI:10.1007/s12029-017-9959-0]
3 Murakami K,Kasajima A,Kawagishi N,Ohuchi N,Sasano H.Microvessel density in hepatocellular carcinoma:Prognostic significance and review of the previous published work.Hepatol Res 2015;45:1185-1194[PMID:25594920 DOI:10.1111/hepr.12487]
4中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版).传染病信息2017;16:705-720[DOI:10.3760/cma.j.issn.1673-9752.2017.07.001]
5 Niska JR,Keane FK,Wolfgang JA,Hahn PF,Wo JY,Zhu AX,Hong TS.Impact of intravenous contrast enhancement phase on target definition for hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(IHC):Observations from patients enrolled on a prospective phase 2 trial.Pract Radiat Oncol 2016;6:e9-16[PMID:26598907 DOI:10.1016/j.prro.2015.08.005]
6 Leon SP,Folkerth RD,Black PM.Microvessel density is a prognostic indicator for patients with astroglial brain tumors.Cancer 1996;77:362-372[PMID:8625246 DOI:10.1002/(SICI)1097-0142(19960115)77:2<362:AID-CNCR20>3.0.CO;2-Z]
7 Rübenthaler J,Paprottka KJ,Hameister E,Hoffmann K,Joiko N,Reiser M,Rjosk-Dendorfer D,Clevert DA.Diagnostic accuracy of contrast-enhanced ultrasound(CEUS)in monitoring vascular complications in patients after liver transplantation-diagnostic performance compared with histopathological results.Clin Hemorheol Microcirc 2017;66:311-316[PMID:28527202 DOI:10.3233/CH-179105]
8 Gürtler VM,Rjosk-Dendorfer D,Reiser M,Clevert DA.Comparison of contrast-enhanced ultrasound and compression elastography in the follow-up after endovascular aortic aneurysm repair.Clin Hemorheol Microcirc 2014;57:175-183[PMID:24595129 DOI:10.3233/CH-141828]
9 Mori N,Mugikura S,Takahashi S,Ito K,Takasawa C,Li L,Miyashita M,Kasajima A,Mori Y,Ishida T,Kodama T,Takase K.Quantitative Analysis of Contrast-Enhanced Ultrasound Imaging in Invasive Breast Cancer:A Novel Technique to Obtain Histopathologic Information of Microvessel Density.Ultrasound Med Biol 2017;43:607-614[PMID:28041744 DOI:10.1016/j.ultrasmedbio.2016.11.009]
10陶一明,王志明.出血坏死表型肝细胞癌肿瘤微血管特征研究.中国普通外科杂志2016;25:985-990[DOI:10.3978/j.issn.1005-6947.2016.07.009]