| Relationship and clinical significance between scale ultrasound withultrasound tissue characterization and Doppler Sonography with CD34, P53protein, Proliferating cell nuclear antigen (PCNA) in Hepatocarcinoma PurposeHepatocarcinoma (HCC) is the most common malignancies. It grows rapidly andcan transfer in and out of the liver. We study the ultrasound character andacoustic densitometry of HCC by scale ultrasound and ultrasound tissuecharacterization. Because the tumor vascularity is the key factor in tumor growand transfer, and for the vascular distribution and blood supply are important inthe diagnosis, therapy and prognosis of hepatocarcinoma, the blood of hepatictumors is detested by color Doppler flow image (CDFI), pulse wave Doppler(PW), color power angiography (CPA), hemodynamic parameters ofhepatocarcinomas were compared. The total blood supply in HCC was checked byDoppler perfusion index (DPI) and Portal Congestive Index (PCI). Therelationship among these parameters with some clinical index and histologic indexwas investigated, so as to provide an objective evidence for early diagnosis andtreatment and assessment prognosis of HCC. Methods: 48 hepatocarcinoma were examined with scale ultrasound,ultrasound tissue characterization CDFI, PW, CPA, DPI. The blood supply inperitumor and intratumor were observed and optimal images were stored in MOdics for analysis. 48 hepatocarcinomas were classified into three types: Small livercancer (10cases), node liver cancer (28cases) and lump liver cancer (10cases) bydiameter of hepatocarcinomas. According to metastasis in the Infer vena cava,portal vein and celiac lymph node, the hepatocarcinomas were categorized intotwo stages: 15 cases of metastasis stage, 33 cases of stage without metastasis.According to Laboratory results, the patients were to three groups: (1) 8 cases ofnormal liver group. (2) 17 cases of chronic hepatitis group. (3) 23 cases of hepaticcirrhosis group.12 cases normal subjects as control group.All case in supine or left lateral position, were examined with 2D grey-scalesonography and Doppler sonography.1. The size, outline and inner echogram of each hepatocarcinomas wereobserved. Th average diameters were recorded. Infer vena cava (IVC), portal veinand the area next to great blood vessels were observed to detect cancer embolicand lymphatic metastasis.2. The integrated backscatter (IBS) including: (1) peak-to-peak amplitude ofthe image intensity, PPI, (2) average image intensity;AII (3) standard devi-anonof image intensity, SDI;AII (AII%), AII%=AII x mean TGC/TGC.1. Peripheral and inter blood flows of 48 hepatic tumors were showed withCDFI. The flow pattern was classed to foue grades: grade 0-3.The pulsatile wave Doppler was taken in the tumor and around the tumor.The angle was less than 30 degree between Doppler sample line and the bloodflow;clear PW spectra were obtained. The pulsatile flows were checked andresistance indexes (RI) were measured.2. The blood supply in area of tumors was observed with CPA.According to the Vascular shape and rich degree of the flow, the patterns of bloodflow were categorized. Pattern I: There were peripheral and peripheral andinternal flows like spot, internal flows like spot. Pattern II: There were and line orwith simple branches. Pattern III: There were rich peripheral and internal flowslike tree branches and nets with complex branches.3. The velocity and diameters of portal vein and common hepatic artery wastaken, then the doppler perfusion index, DPI;and Portal Congestive Index, PCIwere caculated and recorded..4. According to pathology results, hepatocarcinoma were categorized toPattern I-IV.5. The specimens in 48 cases of HCC were obtained by ultrasound guidedneedle biopsy (29 cases) and by operation 19 cases). CD34, p53, proteins weredetected by immunohistochemical technique with SABC, and the tissuemicrovascular density (MVD) was measused in 48 cases of HCC.Results Part one1. The intensity of echo in tumor have not correlations with pathologicalgrades and metastasis, the boundary and even echo of tumer have correlationswith pathological grades and metastasis.2. PPI,SDI,AII% have not correlations with pathological grades andmetastasis in the patients group. The PPI,SDI,AII% in low echo intensity groupand in high echo intensity group ave correlations with pathological grades andmetastasis in the patients group3. The blood supply in HCC by CDFI as follow: total 79 lesions in 48HCC, 9in grade 0, 38 in grade 1, 27 in grade 2, 5 in grade 3. The CDFI pattern of HCCshowed as low blood supply, main showed as dots/lines flow. The checking rate ofCDFI is 88.62%.4. The blood imaging in CPA: 25 in pattern I, 43 in pattern II, and 8 inpattern III. The checking rate of CPA is 96.20%, higher than in CDFI.5. There was a positive correlation between CDFI and CPA with histologyand metastasis. There was a positive correlation between RI and histology.6. DPI and PCI in HCC WAS higher than in normal subjects. If sets DPIlarger than 0.26 as cut point for diagnosis of HCC, the sensitibility and specibilityand accuracy were 93.75%, 94% and 95%, respectively.7. Results using PW: The checking rate of The pulsatile flow in HCC was79.75%, the max velocity was 8.99-88.62cm/s, mean velocity was 39.3 cm/s, RIrange from 0.20 to 1.0, mean RI was 0.71. RI was higher as the HCC larger. RI inmetastasis stage and not metastasis stage was 0.82±0.16, 0.65±0.15, respectively.Part two1. The average MVD in HCC was 36.87±16.79, there was 26 cases for P53expression, the positive rate 54.17%, and 37 cases for PNCA expression, thepositive rate 68.75%. The positive rate for PNCA expression in the HCC whichdiameter more than 3cm was higher than that of which diameter less than 3cm.The position expression rate for CD34 and PNCA in the case with more than onelesions, boundry unclear and cancer thrombus in PV were more higher.2. There was a correlation between AII% with CD34 and PNCA.3. The CDFI and CPA flow pattern of HCC have a positive correlationbetween cd34 and PNCA. The mean MVD for pattern I, pattern II, and pattern IIIof blood imaging in CPA were 26.62±8.38, 35.45±13.01 and 51.55±16.32respectively.4. Results using PW: There were 10 cases, 28 cases, 10 cases in Smallliver cancer, node liver cancer and lump liver cancer respectively. The MVDof the three grades were 20.22±7.81% ,38.53±13.18%,53.47±22.67%,RIwere 0.61±0.10,0.71±0.12,0.82±0.08, respectively. There was a positivecorrelation between RI and CD34, p53 and PNCA (r=0.725, =0.000;r=0.436,P=0.007;r=0.628, P=0.00, respectively)5. The MVD, P53 AND PNCA of metastasis stage are significantdifferences from that of stage without metastasis The positive rates of p53 ofstages were 52.00%, 100% respectively. There were significant differencesbetween the MVD, RI, the positive rates of p53, PCNA of metastasis stage fromstage without metastasis.Conclusions:1. The boundary and even echo of tumer have correlations with pathologicalgrades and metastasis.2. The PPI,SDI,AII% in low echo intensity group and in high echo intensitygroup ave correlations with pathological grades and metastasis in the patientsgroup.3. The blood flow grading by CDFI, CPA can reflect the angiogenesisactivity of hepatic carcinoma to some extent.4. Hemodynamic parameters (RI) of hepatic carcinoma, have somecorrelations with diameter and metastasis of carcinoma. They maybe reflect theangiogenesis character of hepatocarcinoma from different angle.5. Doppler sonography of hepatocarcinoma can be used as a non-invasivemethod to evaluate the angiogenesis activity of hepatic carcinoma and can providea objective evidence for the treatment and assessment of prognosis.6. DPI larger than 0.26 as cut point for diagnosis of HCC, the ensitibility andspecibility and accuracy were 93.75%, 94% and 95%, respectively.7. There was a correlation between AII% with CD34 and PNCA.8. Hemodynamic parameters (RI) of hepatic carcinoma, MVD and theexpression of p53, PCNA have some correlations with diameter and metastasis ofcarcinoma. They maybe reflect the angiogenesis character and histology characterof hepatocarcinoma from different angle.
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