| Part I:Assessment the stiffness of primary liver cancer: The relationship between virtual touch tissue quantification and collagen percentage assay.Objective To study the relativity between virtual touch tissue quantification (VTQ) and collagen percentage assay in the stiffness of primary liver cancer(PLC). The relativity can play a potential role in using VTQ to evaluate the benign and malignant of tumor.Methods 40 cases of primary liver cancer by operation and pathology were selected from the 187 patients detected focal liver lesions in 2012 July-2014 June to China-Japan Friendship Hospital for ultrasonic examination. They included 36 cases of hepatocellular carcinoma(HCC),1 cases of Intrahepatic cholangiocarcinoma(ICC) and mixed type of hepatic carcinoma in 3 case. There were 26 males,14 females, aged 11-80 years, mean age 56.05+16.16 years.Before operation, VTQ was used to detect the forty patients with PLC to obtain the shear wave velocity(SWV) of tumor and noncancerous tissues. The lesions smaller than 3cm were took a point at the center for measuring the SWV. The lesions larger than 3cm were avoided the liquefaction necrosis parts, respectively in the center of lesion location and the surroundings 3-5 points for the determination of SWV. When measured the SWV of noncancerous tissues, the region of interest was apart from the tumor edge 1-5cm. Measurement of all SWV were accomplished by a doctor with skilled operation. After operation,the pathology specimens of tumor and noncancerous tissues were sectioned,and then stained respectively with Sirius red and Masson.The staining procedures were strictly in accordance with the reagent instructions. The collagen proportionate areas were measured by microscopic image analyzer. The average collagen proportionate areas represented the contents of collagen. The differences between groups and the correlation between SWV and the contents of collagen were statistically studied by SPSS17.0.Results1. Significant differences in SWV value appeared between tumor and noncancerous tissues [(2.82±0.68) m/s vs. (1.66±0.47) m/s,p<0.05].2. There were significant differences in collagen percentage assay between tumor and noncancerous tissues [Sirius red group:(74.68±11.29)%vs. (41.59±17.85)%, p<0.05; Masson group:(75.47±11.11)%vs. (40.41±17.12)%,p<0.05].3. The SWV before operation was correlated positively to collagen percentage assay (Sirius red group:r=0.70 P<0.05, Masson group:r=0.73 P<0.05) of histological section after operation. Sirius red staining group:collagen content on the regression equation of SWV value is "Y=39.56+12.47X"; Masson staining group:collagen content on the regression equation of SWV value is "Y=41.78+11.96X".Conclusions SWV value calculated by VTQ has reasonable correlation with collagen percentage assay of tumors. It is a valuable index for quantitative evaluation of the stiffness of liver cancer,which is useful for the differential diagnosis of PLC.Part II:Comparative study between shear wave velocity, quantitative parameters of contrast-enhanced ultrasound and micro vessel density in primary liver cancer.Objective To investigate the relativity between shear wave velocity(SWV), quantitative parameters of contrast-enhanced ultrasound and micro vessel density (MVD) of histological section with immunohistochemistry in primary liver cancer(PLC).Methods 39 cases of primary liver cancer by operation and pathology were selected from the 187 patients detected focal liver lesions in 2012 July-2014 June to China-Japan Friendship Hospital for ultrasonic examination. They included 35 cases of hepatocellular carcinoma(HCC),1 cases of Intrahepatic cholangiocarcinoma(ICC) and mixed type of hepatic carcinoma in 3 case. There were 25 males,14 females, aged 26-80 years, mean age 57.21+14.61 years.Before operation,VTQ was used to detect the 39 patients with PLC to obtain the SWV of tumor. The lesions smaller than 3cm were took a point at the center for measuring the SWV. The lesions larger than 3cm were avoided the liquefaction necrosis parts, respectively in the center of lesion location and the surroundings 3-5 points for the determination of SWV. When measured the SWV of noncancerous tissues, the region of interest was apart from the tumor edge 1-5cm. Then, Then, we detected the 39 patients with PLC by contrast-enhanced ultrasound(CEUS) examination. Begin timing and recording the dynamic image,we observed dynamic enhancement course of liver lesions. The Q1ab software was used to draw time-intensity curve (TIC) and get quantitative parameters of CEUS. After operation,stained the pathology specimens of tumor tissues with CD34. The staining procedures were strictly in accordance with the reagent instructions. The MVD were measured by microscope. The SWV and the quantitative parameters of CEUS were compared with MVD of tumor respectively by SPSS17.0.Results1. The mean SWV in tumor tissues of these PLC was 2.84±0.68m/s; the peak intensity time was 25.05±4.18s, peak accelerating time was 14.91±4.59s, the enhancing slope rate was 2.30±0.15dB/s in CEUS;2. The enhancing slope rate was positively correlated to MVD (r=0.696, P<0.05) The peak intensity time and peak accelerating time were negatively correlated to MVD (r=-0.632, P<0.05; r=-0.781, P<0.05).Conclusions SWV reflected tumor blood supply indirectly need to be studied deeply in the future. The quantitative parameters of CEUS were well correlated to MVD of tumor. The quantitative parameters of CEUS are valuable for quantitative evaluation of tumor blood supply. |
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