| Baekground and purpose:Hepatocellular carcinoma(HCC) is the third malignancy tumor of the liver in our country and the predicting prognosis is very bad.Angiogenesis plays an important role to the growth and metastasis of the tumor. Tumor is controlled by a number of angiogenic angiogenesis factors, among which vascular endothelial growth factor(VEGF) and placenta growth factor(PLGF) play important roles in neovascularization, and it has been proved that VEGF and PLGF may be related to aggressiveness and prognosis of many solid tumors. The microvessel density(MVD) is now widely used to evaluate the tumor giogenesis, and has been proved to correlate with the tumor infiltration and prognosis.All imaging features are based on their pathological nature and detennined by biological beheviors, the use of spiral CT(SCT) has proved to be an effective method in early diagnosis treatment as well as predicting prognosis of HCC. so that a comparison between SCT features and their biologic behaviors may devote to the relationship between modern medical imaging and molecular biology. The purpose of our study was to evaluate the correlation between SCT features and the expression of VEGF,PLGF and MVD in carcinoma, investigate the ability of SCT assessing tumor neovascularization, understand deeply the significance of CT features of HCC and obtain more information for its diagnosis, selection of treatment decision and prognosis by SCT.Materialsandmethods:39 patients of HCC which proved by pathology and had never been treated with non-operative management. Among them 30 cases of male and 9 cases of female, the age from 32-81, The expression of VEGF, PLGF and MVD was examined by means of SP immunohistochemical technique. Microvessel counting and calculation of VEGF, PLGF and MVD expression percentage were observed at 400x magnification under the same standard respectively.The correlation of tumor grade with MVD and expression of VEGF, PLGF was analyzed.With a GE LIGHT SPEED 16 helical scanner, After unenhanced spiral CT scans were performed, contrast medium Onipic was injected intravenously with a power injector at a rate of 3.0-4.0ml/s. The volume of contrast medium Onipic was 80-100ml. Three-phases enhanced spiral CT scans were obtained at 25-30s and 50-60s and 90-120s respectively after the beginning of injection.The scan parameters were 130KV,250-300mA, collimation 5-10mm(or 3-5mm), pitch=1. The CT manifestations of pre-operation, including diameter of tumors, capsulae patterns, metastasis and the enhancement patterns(arterial,double and poorly blood supply) were analyzed their relation to MVD and expression of VEGF, PLGF.Statistical analysis was executed by SPSS 13.0 software.The enumeration data of the groups were compared using t-test and analysis and variance, the binaty data were compared using x2-test, significant level p<0.05.Results:1.The expression and relation of MVD,VEGF, PLGF in HCC.Of 39 patients, VEGF expression was detected in 33 tumors, the VEGF positive were 84.62%; PLGF expression was detected in 30 tumors, the PLGF positive were 76.92%;The mierovessel densities ranged from 16 to 59 with a mean of 32.79(standarddeviation,14.25).There were close relation-ship between the positive expression of VEGF and PLGF(x2= 7.59, P=0. 018).The mierovessel densities were 35.67±13.63 in VEGF positive tumors and 17.0±1.41 inVEGF negative tumors, The mierovessel densities were 35.46±14.02 in PLGF positive tumors and 23.89±11.69 in PLGF negative tumors, the differences were both statistically significant (p=.002;0.031).There were significant relation in HCC between the positive expression of MVD, PLGF and pathologie grade(p=0.001;0.034)2.The result of HCC with SCT imagesOf 39 HCCs, arterial blood supply type was seen in 26 (66.67%), double blood supply in 10(25.64%),poorly blood supply type in 3(7.69%); 18 tumors larger than 5cm with diameter,21 tumors diameter less than 5cm; The well-encap sulated tumors in 11,the poor-encap sulated tumors in 28;of 13 danger patients,4 small tumors were detected around the main tumor,5 patients were found tumor-emboli in portal veins, lymphatic metastasis in 2,both lymphatic metastasis and tumor-emboli in portal veins were 2 cases.3.The correlation of CT features and expression of VEGF, PLGF and MVD3.1 There were statistic differences of VEGF, PLGF and MVD positive between arterial blood and poorly blood supply HCC respectively (p=0.023,0.022,0.001); In HCC with arterial blood of PLGF and MVD expression level was higher than that with double blood supplies (p=0.031,0.004), they were no statistically significant correlations of VEGF level (P=0.465); there were no obvious correlations of VEGF, PLGF and MVD expression level between double blood and poorly blood supply HCC respectively(P=0.133,0.500,0.138).3.2 The poor or no-encap sulated tumors of VEGF expression level were higher than those with well-encap sulated ones (p=0.004); there were no statistically significant correlations with PLGF and MVD level between them(p=0.194,0.20).3.3 There were no obvious correlations of VEGF expression level between metastasis and no metastasis (P=0.333), The metastasis groups of PLGF and MVD expression level were higher than those with no metastasis groups (p=0.015;0.003).3.4 There was no statistieally significant correlation with diameter between the expression of VEGF and PLGF(p=0.590,0.312);Of MVD expression the larger tumors were higher than the smaller ones, there were statistically significant correlations (p=0.019)Conclusion:1.There is a close correlation between the expression of VEGF and PLGF, when they are positive expressions,The MVD is obvious adding.It is indicated that VEGF and PLGF have important effects in the angiogenesis formation of HCC.2.The pathologic grading of HCC was positively correlated with MVD and expression of PLGF. it is demonstrated that with the tumor become larger,the higher grade and more blood would be needed, PLGF and MVD can evaluate pathologic grading of HCC at a level. The angiogenesis may be an important role along with the tumor.3.The results showed that the features of HCC, including encaps, metastasis and the enhancement patterns were significantly related to MVD and expression of VEGF,PLGF, it is indicated that the morphological bases of HCC in growth, aggressiveness are tumor angiogenesis, VEGF,PLGF and MVD may reflect the blood supply types of HCC.4.CT features of HCC are influenced by many factors including angiogenesis, the expression of VEGF,PLGF and other factors together.To analyze the relationship between CT fatures and tumor neovascularization of HCC, the characteristic of CT can be further realized.we can also evaluate the biological features and predict the blood supply types.Therefore, more-phase enhanced SCT scans can provide more helps in the diagnosis, the selection of therapy and prognosis of HCC... |
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