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目的探讨原发性肝细胞癌(HCC)癌前病变血液动力学的特征。方法用MR灌注扫描(MR perfusion,MRP)的方法对实验诱发大鼠肝脏的HCC癌前病变阶段到癌变阶段的血液动力学进行动态观察。结果在MR T2WI检出并与病理对应良好的46个结节中有9个再生结节(regenerative nodule,RN)、22个HCC癌前病变即发育不良结节(dysplastic nodule,DN)、10个早期HCC和5个HCC。RN、DN、早期HCC和HCC结节及邻近肝实质的平均阳性强化积分值(positiveenhancement integral,PEI)分别为205·67±31·17、161·94±20·74、226·09±34·83、491·86±44·61、204·84±70·19。将结节PEI值和结节旁肝组织PEI值对比,发现9个RN与邻近肝实质差异无统计学意义(t=-5·30,P=0·06),MRP图像的动脉期和门脉期RN均呈等信号;DN较邻近肝实质低,并有统计学意义(t=-3·64,P=0·02),DN的血流灌注曲线于动脉后期较邻近肝实质下降,MRP图像动脉期呈等信号,门脉期为低信号。10个早期HCC中4个结节表现为低灌注,PEI值低于邻近肝实质,动脉期呈稍低信号,门脉期为等信号;6个早期HCC显示为稍高灌注,PEI值稍高于邻近肝实质,动脉期为稍高信号,门脉期呈稍低信号。5个HCC呈典型的动脉期明显强化、门脉期呈相对低信号,结节灌注曲线动脉段较邻近肝实质有明显抬高,结节较邻近肝实质的PEI明显增大,差异有统计学意义(t=3·74,P=0·02)。结论MRP能反映HCC癌前病变结节演变过程中血流的改变,HCC的血流灌注量较邻近肝实质明显增多;DN的血流灌注量较邻近肝实质减少。
Objective To investigate the hemodynamic characteristics of precancerous lesions in primary hepatocellular carcinoma (HCC). Methods The MR perfusion (MRP) method was used to observe the hemodynamics of HCC precancerous lesions and carcinogenesis in experimental rats. Results Among the 46 nodules detected by MR T2WI and corresponding well with pathology, there were 9 regenerative nodules (RNs), 22 HCC precancerous lesions (dysplastic nodules, DN), 10 Early HCC and 5 HCCs. The average positive PEI for RN, DN, early HCC and HCC nodules and adjacent liver parenchyma were 205.67 ± 31.17, 161.94 ± 20.74, 22.69 ± 34.0 83,491 · 86 ± 44 · 61, 204 · 84 ± 70 · 19. Comparing the nodule PEI value with the nodal liver tissue PEI value, we found there was no significant difference between the 9 RN and the adjacent liver parenchyma (t = -5 · 30, P = 0.06). The arterial phase and the gate The RN of RN was equal signal in the pulse phase. DN was lower than that of the adjacent liver and had statistical significance (t = -3.64, P = 0.02). The perfusion curve of DN decreased in the late arterial phase compared with the adjacent liver parenchyma, MRP images showed arterial phase signal, portal phase is low signal. The four nodules of 10 early HCC showed hypoperfusion, PEI value was lower than adjacent liver parenchyma, arterial phase was slightly lower signal, portal phase is equal signal; 6 early HCC showed slightly hyperperfusion, PEI value slightly higher In the vicinity of the liver parenchyma, the arterial phase is slightly higher signal, the portal vein was slightly lower signal. Five HCC showed typical arterial phase was significantly enhanced, portal phase was relatively low signal, nodular perfusion curve artery segment was significantly higher than the adjacent liver parenchyma, adjacent to the liver parenchyma PEI significantly increased, the difference was statistically significant Significance (t = 3.74, P = 0.02). Conclusions MRP can reflect the changes of blood flow during the development of precancerous lesions of nodules. The perfusion of HCC is obviously higher than that of adjacent parenchyma. The blood perfusion of DN is lower than that of adjacent parenchyma.