| PARTⅠ Study on imaging of hepatocyte carcinoma DWI,IVIM-DWI and its correlation with histological differentiationObjective:To investigate the value of DWI and IVIM-DWI in differentiating hepatocellular carcinoma(HCC)from normal liver tissue and its correlation with the degree of pathological differentiation of HCC.Methods:Collect 35 patients with hepatocellular carcinoma who were diagnosed in our hospital and confirmed by operation and pathology during August 2017 to December 2008.All patients underwent routine liver MRI(including T1WI,T2WI,DWI)and IVIM-DWI sequence(b value:0,20,40,80,120,200,400,800,1000 s/mm2)scans.Mapping the areas of interest in tumors and normal liver tissue on MRI images at the same level(avoid cystic degeneration,liquefaction necrosis and bleeding areas).True diffusion coefficient(D),pseudo diffusion coefficient(D*),perfusion coefficient(f)and apparent diffusion coefficient(ADC)were obtained by Siemens Workstation and MITK postprocessing software.Surgical resection of specimens by HE staining and histological grading according to Edmondson-Steiner system,which were divided into 5 cases with low differentiation,21 cases with middle differentiation and 9 cases with high differentiation.Statistical analysis software SPSS 19.0 was used to analyze the resulting data.The D and f values of the same level HCC tissue were compared with those of nonnal liver tissue by two-samples t-test.The comparison of D*,ADC and high-medium-low-differentiated parameters of each group was carried out by Kruskal-Walis test.Spearman rank correlation was used for inter-group correlation analysis.The ROC curve showed the diagnostic efficacy of each parameter.The difference was considered to be statistically significant with P less than 0.05.Results:1.Compared with normal liver tissues,ADC value and D value of HCC while f value and D*value increased,and the variation of each parameter was statistically significant(P<0.05).2.D value was statistically significant in different differentiation groups(P<0.05),and was a significant positive correlated with the degree of HCC differentiation(r=0.659,P<0.001).ADC values showed statistically significant differences between high-medium differentiation and high-low differentiation,showing a mild positive correlation with the degree of differentiation of HCC(r=0.326,P<0.001).There was no significant difference between groups of f and D*values(P>0.05).ADC values and D values showed similar diagnostic efficacy in differentiating high and middle differentiated HCC patients.ADC=1.002 × 10-3mm2/s,D=0.979 × 10-3mm2/s were used as threshold values to have the best diagnostic performance.The area under the curve was 0.764 and 0.765,respectively.D=0.739 × 10-3mm2/s had the best diagnostic performance in the identification of moderately and poorly differentiated HCC.Conclusion:1LDWI and IVIM-DWI have important significance in differentiating hepatocellular carcinoma from normal liver tissue,and IVIM-DWI parameters have higher accuracy.2.IVIM-DWI can more realistically reflect the density of cancer cells,and has more advantages in differentiating the degree of HCC differentiation,which can be used as a clinical means to evaluate the degree of pathological differentiation of HCC in vivo.PART Ⅱ Correlation between IVIM-DMI imaging of hepatocellular carcinoma and microcirculation status of hepatocellular carcinomaObjective:To investigate the correlation between IVIM-DWI parameters and MVD,Ki-67 in hepatocellular carcinoma with different pathological differentiation.Methods:The patient’s collection,MRI examination and HE staining were the same as the first part.Immunohistochemical staining was performed on the surgically removed specimens of all patients to obtain MVD value and ki-67 index.Statistical analysis software SPSS 19.0 was used to analyze the resulting data.The relationship between MVD and Ki67 indexes was calculated by Kruskal-Wallis test.The association of MVD and Ki67 index with IVIM-DWI parameters was calculated by Spearman rank correlation.The difference was considered to be statistically significant with P less than 0.05.Results:1.Ki-67 index index and MVD value were negatively correlated with the differentiation degree of HCC(r=-0.814,r=-0.639).2.ADC value has no correlation with MVD and Ki-67 index(P>0.05).D value was slightly negatively correlated with MVD and Ki-67 index(r=-0.216,P=0.027.r=-0.378,P<0.001).D*value was a significant positive correlated with MVD and Ki-67 index(r=0.642,r=0.653,P<0.001).f value was moderately positively correlated with MVD Ki-67 index(r=0.522,r=0.536,P<0.001).2.Conclusion:IVIM-DWI can replace histological examination to some extent and become a new model for evaluating the functional status of HCC. |
PDF Full Text Request