| Objective To investigate the imaging features of clear cell hepatocell ular carcinoma(ccHCC),analyze its correlation with pathological grade,a nd compare it with non-clear cell hepatocellular carcinoma(non-ccHCC),so as to improve the understanding and diagnosis of this disease.Methods A retrospective analysis was made of 52 cases of clear cell hepatocellular carcinoma confirmed by operation and pathology in the Fir st Affiliated Hospital of Guangxi Medical University from June 2012 to March 2019.They were divided into experimental group and 79 cases of opaque cell hepatocellular carcinoma as control group.All cases underwen t preoperative imaging examination(CT/MRI and enhanced scan).The con tents of imaging,clinic and pathology were observed and recorded.Imagi ng included the location,number,shape,size and boundary of the lesions in each group;whether there was necrosis,hemorrhage,fat in the tumors,and whether there was pseudocapsule formation around the tumors;enha ncement characteristics,enhancement methods and quantitative analysis;in vasion and metastasis of tumors(intrahepatic,lymph node and distant met astasis,etc.).Clinical manifestations,laboratory examinations(AFP,tumormarkers,liver function,etc.)and prognosis were included.Pathology inclu des histopathological grading of tumors,capsule,vascular tumor thrombus,nerve invasion,capsule invasion and liver tissue around tumors(inflamm ation,fibrosis,cirrhosis).According to Edmonson's histological grading,the y were divided into three groups: grade I,grade II and grade III.The me asurement data were analyzed by independent sample t test or single facto r analysis of variance.The counting data were analyzed by chi-square test.The correlation between each imaging index and pathological grading wa s compared by Spearman rank correlation analysis.The diagnostic efficacy of CT quantitative index was analyzed by ROC curve.SPSS 20.0 statisti cal analysis software was used for statistical processing and analysis.Results 1.In the ccHCC group,there were significant differences in t he pathological grade of tumors in morphology,density/signal uniformity,necrosis and enhancement(P < 0.05),but there were no significant differe nces in the pathological grade of tumors in location,size,boundary,hemo rrhage,steatosis and pseudocapsule(P > 0.05).There were no significant differences in plain scan CT value,enhanced phase III CT value,absolute enhancement value and relative enhancement rate between pathological gr ades of ccHCC(P > 0.05).Relative analysis showed that CT value of pl ain scan,CT value of arterial phase,absolute enhancement value and relat ive enhancement rate were positively correlated with pathological grade,w hile CT value of venous phase,delayed phase,absolute enhancement valu e and relative enhancement rate were negatively correlated with pathologic al grade.The correlation coefficient of relative enhancement rate of arteria l phase was higher(r=0.267)and had statistical significance(P<0.05).2.C ompared with the non-ccHCC group,there was significant difference in capsule formation between the two groups(P < 0.05),but there was no sig nificant difference in intratumoral hemorrhage/necrosis,vascular cancer thr ombus,capsule invasion and paracancerous cirrhosis(P > 0.05).There we re significant differences in tumor morphology,pseudocapsule and enhance ment pattern(P < 0.05),but there were no significant differences in tumo r location,size,boundary,density/signal uniformity,hemorrhage,necrosis,steatosis and accompanied invasion/metastasis(P > 0.05).There were signi ficant differences in CT value,absolute enhancement value and relative en hancement rate between the two groups(P < 0.05),while there was no si gnificant difference in CT value between the two groups(P > 0.05).3.An alysis of diagnostic efficacy of CT quantitative indicators for differentiatin g ccHCC from non-ccHCC: The higher AUC under ROC curve were arte rial phase CT value(AUC = 0.762),arterial phase absolute enhancement value A1(AUC = 0.758)and arterial phase relative enhancement rate R1(AUC = 0.779).When arterial phase CT value was less than 83 HU,th e sensitivity and specificity of diagnosing HCC were 78.33% and 67.53%,respectively;when arterial phase absolute enhancement value was less th an 34,the sensitivity and specificity of diagnosing HCC were 67.53%.Th e sensitivity and specificity of diagnosing ccHCC were 68.33% and 74.03%,respectively.When the relative enhancement rate of arterial phase wa s less than 1.21,the sensitivity and specificity of diagnosing ccHCC were80.00% and 72.73%.4.There was no significant difference in recurrence and metastasis between ccHCC and non-ccHCC(P > 0.05).There were sig nificant differences in pathological grade of ccHCC(P<0.05),but there w ere no significant differences in pathological grade of tumor location,size,border,hemorrhage,steatosis and pseudocapsule(P>0.05).Conclusion 1.The imaging features of ccHCC are correlated with pat hological grading:(1)Edmonson grade I and II lesions are more round th an grade III lesions,with homogeneous intratumoral density/signal and les s necrosis than grade III lesions;(2)Edmonson grade I and II lesions ha ve mild to moderate enhancement,slow in and out,fast in and slow out,edge enhancement and other atypical enhancement modes are more com mon than grade III lesions.2.There are some differences in imaging featu res between ccHCC and non-ccHCC:(1)round tumors,pseudocapsular sig ns and atypical enhancement modes of ccHCC are more common than th ose of non-ccHCC;(2)the CT value,absolute enhancement value and rel ative enhancement rate of ccHCC are lower than those of non-ccHCC at all stages of enhancement;(3)enhanced arterial CT value,absolute enhan cement value(A1)and relative enhancement rate(R1)have certain diagno stic value for ccHCC.Therefore,by observing the morphology of the tum ors,enhancement methods and quantitative analysis of CT,it has certain value for the diagnosis of ccHCC,and can provide imaging reference for preoperative diagnosis and prediction of hepatocellular carcinoma types.3.There is no significant difference in clinical features and prognosis betwee n ccHCC and non-ccHCC. |
PDF Full Text Request