肝细胞癌患者CT表现及对病理分级的诊断价值
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摘要
目的探讨肝细胞癌患者CT表现及对病理分级的诊断价值。方法选取2016年9月至2017年9月在我院诊治的肝细胞癌并进行部分肝切除术患者500例,术前进行CT增强扫描,观察CT扫描供血分型及CT征象中肿瘤大小、门静脉或肝静脉癌栓、肿瘤内坏死、肝硬化、淋巴结肿大等情况,并将CT检查结果与术后病理结果进行对比,分析CT检查结果与病理分级关系。结果本研究500例肝细胞癌患者,肝细胞癌患供血分型为:肝动脉型317例(63.40%)、肝动脉和门静脉双重供血型126例(25.20%)、少血供型57例(11.40%)、门静脉供血型0例。CT扫描肿瘤大小、门静脉或肝静脉癌栓,与手术病理结果比较,差异无统计学意义(P>0.05);CT扫描肿瘤内坏死、肝硬化、淋巴结肿大,与手术病理结果比较,差异有统计学意义(P<0.05)。病理分级Ⅰ、Ⅱ级70例(62.50%),Ⅲ、Ⅳ级42例(37.50%),其中CT显示肿瘤范围越大、边缘清楚、有肿瘤内出血坏死、有侵袭转移者,肿瘤分级均较高,差异有统计学意义(P<0.05)。结论肝细胞癌患者CT表现能为病理分级提供客观参考依据,有一定的诊断价值。
Objective To explore the CT findings and their diagnostic value of pathological grading in patients with hepatocellular carcinoma.Methods A total of 500 cases of patients who diagnosed as hepatocellular carcinoma and treated with partial hepatectomy in our hospital from September 2016 to September 2017 were selected,and they were given CT enhanced scan before operation.The blood supply types of CT scan and the CT signs of tumor size,portal vein or hepatic vein tumor thrombus,necrosis in the tumor,liver cirrhosis and lymphadenopathy were observed.The CT findings were compared with postoperative pathological results,and the relationship between CT findings and pathological grading was analyzed.Results Among 500 patients with hepatocellular carcinoma in this study,317 cases(63.40%)were hepatic artery type,126 cases(25.20%)were dual blood supply type of hepatic artery and portal vein,and 57 cases(11.40%)were less blood supply type and 0 case was portal vein blood supply.There were no statistically significant differences in tumor size,portal vein or hepatic vein tumor embolus of CT scan compared with those of surgical pathology results(P>0.05).There were statistical significant differences in the necrosis in the tumor,liver cirrhosis and lymphadenopathy of CT scan compared with those of surgical pathology results(P<0.05).There were 70cases(62.50%)in pathological grades I and II and 42 cases(37.50%)in grades III and IV.CT showed that the larger cancer cells,the clearer edges,hemorrhage and necrosis in the tumor,and invasion and metastasis all resulted in a higher tumor grade(P<0.05).Conclusion CT findings of patients with hepatocellular carcinoma can provide an objective reference for pathological grading,and it has a certain diagnostic value.
Objective To explore the CT findings and their diagnostic value of pathological grading in patients with hepatocellular carcinoma.Methods A total of 500 cases of patients who diagnosed as hepatocellular carcinoma and treated with partial hepatectomy in our hospital from September 2016 to September 2017 were selected,and they were given CT enhanced scan before operation.The blood supply types of CT scan and the CT signs of tumor size,portal vein or hepatic vein tumor thrombus,necrosis in the tumor,liver cirrhosis and lymphadenopathy were observed.The CT findings were compared with postoperative pathological results,and the relationship between CT findings and pathological grading was analyzed.Results Among 500 patients with hepatocellular carcinoma in this study,317 cases(63.40%)were hepatic artery type,126 cases(25.20%)were dual blood supply type of hepatic artery and portal vein,and 57 cases(11.40%)were less blood supply type and 0 case was portal vein blood supply.There were no statistically significant differences in tumor size,portal vein or hepatic vein tumor embolus of CT scan compared with those of surgical pathology results(P>0.05).There were statistical significant differences in the necrosis in the tumor,liver cirrhosis and lymphadenopathy of CT scan compared with those of surgical pathology results(P<0.05).There were 70cases(62.50%)in pathological grades I and II and 42 cases(37.50%)in grades III and IV.CT showed that the larger cancer cells,the clearer edges,hemorrhage and necrosis in the tumor,and invasion and metastasis all resulted in a higher tumor grade(P<0.05).Conclusion CT findings of patients with hepatocellular carcinoma can provide an objective reference for pathological grading,and it has a certain diagnostic value.
引文
[1]陶一明,王志明.出血坏死表型肝细胞癌病理特征及预后的前瞻性初步研究[J].中国普通外科杂志,2016,25(1):6-11.
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[11]李万湖,董帅,胡旭东,等.多层螺旋CT血管造影对原发性肝癌动静脉瘘和肝外供血动脉评估价值[J].中华肿瘤防治杂志,2017,24(11):755-758.
[12]吴英宁,陆玉敏,李恒国,等.肝细胞癌CT表现与手术病理对照及其与血管内皮生长因子表达的关系[J].实用放射学杂志,2016,32(7):1063-1065+1084.
[13]游幼匡,段少银.甲胎蛋白阴性肝细胞癌的CT特征[J].中国医学影像学杂志,2016,24(5):360-363.
[14]王东旭,丁国旭,张天宇,王余广,冯立民.肝细胞肝癌多层螺旋CT表现与微血管侵犯关系的研究[J].临床放射学杂志,2017,36(12):1892-1895.
[15]王夏婉,刘星雨,高剑波,等.原发性透明细胞型肝癌的CT表现与病理对照观察[J].临床放射学杂志,2017,36(9):1267-1270.
[2]李巍,邓丽娟,唐强,等.肝癌病理诊断中肝组织雌激素受体α表达的分析[J].罕少疾病杂志,2017,24(5):26-27.
[3]李辉,张庆雷,刘松,等.19例混合型肝癌临床病理特点及增强CT表现分析[J].中国CT和MRI杂志,2016,14(5):81-84.
[4]李辉,张庆雷,刘松,等.19例混合型肝癌临床病理特点及增强CT表现分析[J].中国CT和MRI杂志,2016,14(5):81-84.
[5]王可,郭小超,王鹤,等.CT和MRI对乙肝肝硬化背景下肝细胞癌诊断评分的一致性:基于LI-RADS的多中心、个体内对照研究[J].放射学实践,2016,31(4):291-295.
[6]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)[J].中华消化外科杂志,2017,16(7):705-720.
[7]陆玉敏,吴英宁,李恒国.肝细胞性肝癌影像表现与手术预后的相关性研究[J].临床放射学杂志,2016,35(11):1718-1721.
[8]龙莉玲,彭鹏,黄仲奎.原发性肝癌的早期影像学诊断[J].中华肝脏病杂志,2017,25(5):329-332.
[9]王之龙,朱旭,高顺禹,等.CT减影法评价肝细胞癌TACE后残余肿瘤活性的研究[J].介入放射学杂志,2017,26(1):64-68.
[10]陆玉敏,吴英宁,李恒国.肝细胞性肝癌影像表现与手术预后的相关性研究[J].临床放射学杂志,2016,35(11):1718-1721.
[11]李万湖,董帅,胡旭东,等.多层螺旋CT血管造影对原发性肝癌动静脉瘘和肝外供血动脉评估价值[J].中华肿瘤防治杂志,2017,24(11):755-758.
[12]吴英宁,陆玉敏,李恒国,等.肝细胞癌CT表现与手术病理对照及其与血管内皮生长因子表达的关系[J].实用放射学杂志,2016,32(7):1063-1065+1084.
[13]游幼匡,段少银.甲胎蛋白阴性肝细胞癌的CT特征[J].中国医学影像学杂志,2016,24(5):360-363.
[14]王东旭,丁国旭,张天宇,王余广,冯立民.肝细胞肝癌多层螺旋CT表现与微血管侵犯关系的研究[J].临床放射学杂志,2017,36(12):1892-1895.
[15]王夏婉,刘星雨,高剑波,等.原发性透明细胞型肝癌的CT表现与病理对照观察[J].临床放射学杂志,2017,36(9):1267-1270.