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MRI诊断大鼠肝癌形成的临床价值

作者：李俊林 1 王丽娜 2 张雪峰 1 孙磊 3

单位：1. 内蒙古自治区人民医院影像医学科呼和浩特 010017 2. 内蒙古自治区人民医院超声医学科呼和浩特 010017 3.首都医科大学附属北京地坛医院病理科北京 100015

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出版年,卷(期):页码：2015,7(3):120-126

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摘要：目的通过大鼠肝癌模型的建立，评价MRI（magnetic resonance imaging）在肝癌的发生发展过程中的影像学诊断价值，为肝癌的早期诊断提供依据。方法 32只大鼠饮用DEN（diethylnitrosamine）后成功建立大鼠肝癌模型，在肝硬化基础上出现的肝细胞结节包括再生结节（regenerative nodule，RN）、不典型腺瘤样增生结节（dysplastic nodule，DN）、肝细胞癌（hepatocellular carcinoma，HCC）、囊肿和血管瘤，经过PROPELLER（periodically rotated overlapping parallel lines with enhanced reconstruction） MRI（弥散加权，T2、T1加权及部分增强）扫描，测量每个肿瘤的表面弥散系数（apparent diffusion coefficient，ADC）值和T2值。每个类型的肝细胞结节测量ADC和T2值，最后经组织病理学证实影像学诊断。结果 PROPELLER图像和结合参数图像是内在的相互配准，无明显的图像失真或运动伪影。在常规的T1和T2加权图像上肝细胞结节的所有类型显示了复杂的影像特征。囊肿ADC和T2值分别是（4.04 ± 0.28）× 10 -3 mm 2 /s、（1459.8 ± 312.9）× 10 -3 s，显著高于RN、DN、HCC的ADC和T2值，差异具有统计学意义（6组P均＜ 0.001）；血管瘤ADC和T2值分别是（3.57 ± 0.44）× 10 -3 mm 2 /s、（1377.9 ± 228.5）× 10 -3 s，也显著高于RN、DN、HCC的ADC和T2值，差异具有统计学意义（6组P均＜ 0.001）；然而在HCC、DN和RN之间，ADC和T2值无显著性差异；在囊肿和血管瘤之间，ADC和T2值无显著性差异。结论 DEN能够成功诱发大鼠从肝硬化到RN、DN及HCC的多阶段病变过程；多次激发PROPELLER MRI对于定量腹部肿瘤学影像是一种可行的方法；使用PROPELLER MRI技术，定量的ADC和T2测量能够提供固有的互相配准多参数图，图像无扭曲或明显的运动伪影；利用PROPELLER MRI技术在肝癌的早期诊断、疗效评价及预后评估方面提供了理论依据。

Abstract: Objective To evaluate the imaging diagnosis value of magnetic resonance imaging in hepatocarcinogenesis to provide evidences for early stage of hepatocellular carcinoma diagnosis . Methods A liver tumor model of hepatocarcinogenesis model of rats were established after 32 rats drunk with
diethylnitrosamine. Hepatic nodules on the basis of cirrhosis included regenerative nodule (RN), dysplastic nodule (DN), hepatocellular carcinoma (HCC), hamangiom and cyst, and PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction) magnetic resonce imaging (MRI) (diffusion-weighted, T2 mapping, T1-weighted and some contrast enhances) were performed. Apparent diffusion coefficient (ADC) maps and T2 maps of each tumor were generated. ADC and T2 values for each type of hepatic nodule were measured, whose imaging diagnosises were confirmed finally by histopathology. Results PROPELLER images and resultant parametric maps were inherently mutual registration without image distortion or motion artifacts. All types of hepatic nodules displayed complex imaging characteristics within conventional T1- and T2-weighted images. The ADC and T2 value of cyst were (4.04 × 10 -3 ± 0.28× 10 -3 )mm 2 /s, (1459.8 ± 312.9) × 10 -3 s, respectively, and significantly higher than ADC and T2 value of RN, DN, and HCC（P ＜ 0.001）.The ADC and T2 value of hemangioma were (3.57 ± 0.44 ) × 10 -3 mm 2 /s, (1377.9 ± 228.5) × 10 -3 s, respectively, and significantly higher than ADC and T2 value of RN, DN, and HCC (P ＜0.001）too. However, there was no significant difference of ADC and T2 value between HCC, DN, and RN.
Also, there was no significant difference of ADC and T2 value between cyst and hemangioma. Conclusions DEN can successfully induce cirrhosis, RN, DN, and HCC in rats, which include a multistep pathy process. Multishot PROPELLER MRI is a promising method for quantitative abdominal oncologic imaging. Using PROPELLER MRI techniques, quantitative measurements of ADC and T2 could provid inherently mutual registration parametric maps without image distortion or obvious motion artifacts. They provide the theoretical basis for early diagnosis, therapeutic evaluation, and prognosis of HCC by PROPELLER MRI techniques.

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