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Study On The Relationship Between Quantitative Parameter On Contrast-enhanced Ultrasound And Histopathologic Grading And Micro Vessel Density In Hepatocellular Carcinoma

Posted on:2009-02-10Degree:DoctorType:Dissertation
Country:ChinaCandidate:J T LiaoFull Text:PDF
GTID:1114360278454063Subject:Medical imaging and nuclear medicine
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Objective: 1. to compare the difference of quantitative parameters of contrast-enhanced ultrasound (CEUS) time-intensity curve in hepatocellular carcinomas (HCCs) with different histopathologic grading. 2. to investigate the relationship of these parameters and micro-vessel density (MVD) in HCCs.Methods: Forty-four patients with forty-four lesions confirmed as HCC pathologically by surgery were studied, including 18 well-differentiated nodules, 15 moderately differentiated nodules and 11 poor differentiated nodules. Each patient was examined by CEUS using pulse inversion harmonic imaging (PIHI) with low mechanical index and second generation micro-bubble contrast medium (SonoVue, Bracco, Milan, Italy) as echo-enhancing agent within a week before surgery. First the liver was scanned with a conventional sonogram and the Color Doppler flow signals of the lesions were scored. Then CEUS images were observed continually on real time and the entire scanning process was recorded for 5 minutes. Enhancement patterns of each lesion were analyzed during the whole vascular phase, consisting of arterial phase, portal venous phase and parenchymal phase. The regions of interests(ROI) was in the lesions and the paraneoplastic liver parenchyma approximately the same depth, avoiding necrosis and large vessels, and the time-intensity curve was made by QLAB or TIC software. The parameters (enhancement beginning time, peak intensity time, peak intensity of lesion and intensity of the same depth paraneoplastic liver parenchyma) were analyzed, and then these parameters were calculated: peak accelerating time(PAT), enhancing slope rate(ESR), relative peak intensity(RPI) ,peak intensity increasing rate(PIIR). The tumor specimens were stained with hematoxylin eosin (HE) and two professional pathologists, who were blinded to the results from CEUS, evaluated histopathologic grading alone. MVD in nodules were detected by staining immunohistochemically with anti-CD34 antibody.The difference of parameters in HCCs with different histopathologic grading were compared, such as largest average diameters, blood flow grade, enhancement beginning time, peak intensity time, peak accelerating time (PAT) , peak intensity of lesion, ESR,PIIR, and the relationship was analyzed between peak intensity time, peak accelerating time (PAT) , ESR, PIIR and MVD in HCCs.Results : (1)A11 tumors were classified into three groups, well-differentiated HCCs group (n=18) (largest average diameters, 6.5±3.4 cm), moderately differentiated HCCs group (n=15) (largest average diameters, 8.6±3.2 cm), and poorly differentiated HCCs group (n = 11) (largest average diameters, 9.1±3.3cm). There was no statistical significance in the largest average diameters of nodule with different histopathologic grading. (2)There was statistical significance in blood flow grade by Color Doppler sonography between well-differentiated HCC group and poorly differentiated HCC group , but no significant difference in well-differentiated and moderately differentiated HCC group, either in moderately and poorly differentiated HCC groups. (3)Enhancement beginning time and peak intensity of well, moderately, poorly differentiated HCCs group were (14.7±3.4S,15.9±4.1S,14.5±2.8S), (186.4±46.4dB,180.5±35.4 dB,174.7±36.6 dB) , respectively, either with no statistical significance(P >0.05).There was no statistical significance in peak intensity time between well-differentiated HCC group and moderately differentiated HCC group(P > 0.05), but significant difference in well-differentiated HCC group and poorly differentiated HCC group(P< 0.05), and in moderately differentiated HCCs group and poorly differentiated HCC group(P< 0.05). Enhancement time and ESR of well, moderately, poorly differentiated HCCs groups were (16.4±4.1S, 12.3±5.6S, 7.1±1.6S), (12.0±2.9, 17.8±5.6, 25.7±7.5), respectively, both with statistical significance(P <0.05). PIIR of poorly differentiated HCC group was higher than that of well differentiated HCC group(P< 0.05), but there was no significant difference between well-differentiated HCC group and moderately differentiated HCC group(P >0.05), neither between moderately differentiated HCC group and poorly differentiated HCC group(P >0.05).(4)Statistical significance was observed in MVD in well, moderately, poorly differentiated HCC group (P <0.001); (5)Peak intensity time and enhancement time were negatively correlated with MVD(P<0.001 and P<0.001), while ESR and PIIR were positively correlated with MVD (P <0.001 and P<0.01).Conclusion:1. The peak intensity time, peak accelerating time and ESR of different differentiation HCC is different. The peak intensity time and the peak accelerating time in poorly differentiated HCCs was shorter, and ESR was bigger, while they were longer or smaller in well-differentiated HCCs. These parameters reflect indirectly histological differentiation.2. Peak intensity time and peak accelerating time were negative correlated with MVD, and ESR and PIIR were positive correlated with MVD . These parameters of contrast-enhanced time-intensity curve may reflect indirectly micro-vessel density in HCC lesion. CEUS before operation can evaluate the generation of angiogenesis, and has a potential role in choosing treatment, evaluating prognosis, and evaluating effect of anti-angiogenesis drugs.
Keywords/Search Tags:Hepatocellular carcinoma, contrast-enhanced ultrasound, histological differentiation, micro-vessel density
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