Study Of Angiogenesis Of Cirrhosis Nodule And Hepatocellular Carcinoma By Using BOLD MRI

Objective:To investigate the feasibility of the mixture gas-challenge blood oxygen level dependent magnetic resonance (BOLD MR) imaging in the clinical diagnosis of cirrhosis nodules and liver cancer. To study the value of identification of cirrhosis nodules and liver cancer, assessment the angiogenesis in them by using BOLD MR imaging.Subjects and Methods:The study consisted of42patients suffered from HCC and cirrhosis,, who were going to accept OLT (orthopedic liver transplantation) in Oriental Organ Transplant Center of Tianjin First Central Hospital between June2011and January2012and fit the case inclusion criteria,35cases were male and7cases were females. Ages of them ranged from33to67years old(average51.58±8.39years old). All the patients underwent a routine abdominal MRI and the mixture gas-challenge BOLD MRI imaging. Imaging was performed with3.0T MR equipment, carbogen gas (95%O2,5%CO2), oxygen mask device. The BOLD MRI imaging was performed with the gradient echo sequence,9TE (4.92-24.25). Two observers graded image quality, and measured T2*values of the region of interest (ROI), then calculated the value of R2*pre value according to the formula R2*=1/T2*, and the value of R2*difference before and after stimulation of the mixture gas (ΔR2*value). The correlation of the quality score which acquired by the two observers respectively was analysed, then the consistency of the two observers. The reliability and repeatability of the liver lesions T2*value measured by the two observers. The whole liver pathologic specimens of33patients were aquired according to the ROI which drawn in the BOLD MRI images, and the pathological detailed evaluation included the gross evaluation, HE stain and immunohistochemisty stain (CD34\VEGF) evaluation which were carried out after liver transplantation. The MVD was used the Weidner method, and the expression of VEGF was described by quantitative of the immune response integral (IRS). All the lesions were divided into three groups according to the pathological findings:RN, DN and HCC. The difference of R2*pre and ΔR2*value of different nature nodules among the three groups, was compared,and then the ROC curve of R2*pre and ΔR2*value between the two groups of HCC and cirrhosis benign nodules was acquired, which was used to determine the qualitative sensitivity, specificity, and the optimum threshold of the two value in diagnosis liver nodules. The correlation between R2*pre, ΔR2*value and MVD, VEGF IRS value of RN, DN and HCC was analysied. The a value equal to0.05and P value less than0.05were considered to indicate there was a significant difference of the test level.Results:①98BOLD MRI images were acquired in total,2of whose quality grading was level-one,and did not meet the measurement requirements, while the others’grading were two or above and could meet the measurement requirements. The Pearson correlation coefficient of the quality grading by two observers was0.945, and the kappa value of them was0.878(P<0.05), so the parameters measured by two observers had a well consistency.②75nodules were acquired in total.The difference of R2*pre and Δ R2*values among the three groups had statistically significant (P=0.00,0.00),which between RN and the DN did not have statistically significant (P=1.00,0.22), and which between DN and HCC, between RN and HCC both had statistically significant (P=0.00,0.04,P=0.00,0.00respectively).The sensitivity, specificity, the best diagnostic threshold value of R2*pre value in the identification of HCC and cirrhosis benign nodules is75.0,94.6, and47.40respectively; the sensitivity, specificity, the best diagnostic threshold value of ΔR2*value is42.1,99.1,-6.95.③There was a negative correlation between the R2*pre value and the MVD of RN (r=-0.67, P=0.00), and there was no correlation between the R2*pre value and the MVD of DN (r=-0.28, P=0.14), while there was a negative correlation of HCC (r=-0.52, P=0.00). There was no correlation between the R2*pre value,ΔR2*values of RN, DN and HCC and VEGF IRS (all P>0.05), also as ΔR2*values and corresponding MVD (all P>0.05).Conclusion:Liver BOLD MRI imaging has high image quality and feasibility. The sensitivity and specificity of R2*pre value on the identification of benign and malignant cirrhosis nodules are high (75.0%、94.6%). The sensitivity of ΔR2*values on the identification of benign and malignant cirrhosis nodules is low, while the specificity is high(42.1%、99.1%); R2*pre values can be used to quantitatively evaluate the tumor angiogenesis of RN and HCC.