实用肝脏病杂志 ›› 2026, Vol. 29 ›› Issue (5): 725-728.doi: 10.3969/j.issn.1672-5069.2026.05.022

• 肝癌 • 上一篇    下一篇

肝细胞癌患者肝脏MSCT灌注成像参数判断肿瘤微血管密度意义探讨*

周中华, 李东惠, 宾盼, 武海洲, 沈海洋, 邢新博, 李天然   

  1. 100048 北京市 解放军总医院第四医学中心放射诊断科(周中华,宾盼,邢新博,李天然);肿瘤内科(李东惠);检验科(武海洲);中国中医科学院西苑医院血管外科(沈海洋)
  • 收稿日期:2025-12-19 发布日期:2026-09-14
  • 通讯作者: 李天然,E-mail:ltranmd@yeah.net
  • 作者简介:周中华,男,43岁,大学本科,主管技师。E-mail:13141112926@163.com
  • 基金资助:
    北京市自然科学基金重点资助项目(编号:L252049)

Clinical clues of microvessel density exhibited by MSCT perfusion imaging parameters in patients with hepatocellular carcinoma

Zhou Zhonghua, Li Donghui, Bin Pan, et al   

  1. Department of Radiology, Fourth Medical Center, PLA General Hospital, Beijing 100148, China
  • Received:2025-12-19 Published:2026-09-14

摘要: 目的 分析多层螺旋计算机断层扫描(MSCT)灌注成像参数判断肝细胞癌(HCC)患者肿瘤微血管密度(MVD)形成的意义。方法 2023年10月~2025年10月解放军总医院第四医学中心收治的128例HCC患者,均行MSCT灌注成像检查,测定病灶区血流量(BF)、平均通过时间(MTT)、表面通透性(PS)和肝动脉灌注量(HAP)。采用免疫组化法检测肿瘤组织微血管计数单位,将MVD计数≥10个/视野者视为MVD阳性。采用多因素Logistic回归分析影响肿瘤组织MVD阳性的因素。结果 在本组128例HCC患者中,发现MVD阳性102例(79.7%);MVD阳性组肿瘤直径、肿瘤低分化占比、CT参数BF、PS和HAP分别为(7.8±1.2)cm、60.8%、(108.5±20.8)mL/(100 mL·min-1)、(25.5±4.8)mL/(100mL·min-1)和(50.5±7.3)mL/(100 mL·min-1),均显著大于MVD阴性组【分别为(5.5±1.0)cm、30.8%、(84.5±10.1)mL/(100 mL·min-1)、(20.7±3.4)mL/(100mL·min-1)和(42.2±8.2)mL/(100 mL·min-1),P<0.05】,而MTT为(15.9±7.1)s,显著小于MVD阴性组【(19.4±6.1)s,P<0.05】;多因素Logistic回归分析显示,肿瘤直径大、肿瘤低分化、BF≥99.8 mL/(100 mL·min-1)、MTT≤17.4 s、PS≥22.3 mL/(100 mL·min-1)和HAP≥43.3 mL/(100 mL·min-1)为HCC患者肿瘤MVD阳性的危险因素(P<0.05)。结论 MSCT灌注成像参数可能提示肿瘤组织MVD阳性,可帮助临床医生术前判断肿瘤生物学行为,为治疗决策提供依据。

关键词: 肝细胞癌, 多层螺旋计算机断层扫描灌注成像, 微血管密度, 影响因素

Abstract: Objective This study aimed to analyze clinical clues of microvessel density (MVD) exhibited by MSCT perfusion imaging parameters in patients with hepatocellular carcinoma (HCC). Methods A total of 128 patients with HCC were encountered in Fourth Medical Center, PLA General Hospital, between October 2023 and October 2025, and all underwent MSCT perfusion imaging to measure perfusion imaging parameters, such as blood flow (BF), mean transit time (MTT), permeability surface (PS) and hepatic artery perfusion (HAP) at focal lesions pre-operationally. Tissue MVD formation was detected by immunohistochemistry. Multivariate Logistic regression analysis was applied to find impacting factors for MVD formation. Results Of the 128 patients with HCC, MVD was found positive in 102 cases (79.7%); size of tumors, percentage of low differentiation, BF, PS and HAP in patients with positive MVD were (7.8±1.2)cm, 60.8%, (108.5±20.8)mL/(100 mL·min-1), (25.5±4.8)mL/(100mL·min-1) and (50.5±7.3)mL/(100 mL·min-1), all significantly greater than [(5.5±1.0)cm, 30.8%, (84.5±10.1)mL/(100 mL·min-1), (20.7±3.4)mL/(100mL·min-1) and (42.2±8.2)mL/(100 mL·min-1), respectively, P<0.05], while MTT was (15.9±7.1)s, significantly less than [(19.4±6.1)s, P<0.05] in those with MVD negative; multivariate Logistic regression analysis showed that tumor size, low differentiation, BF≥99.8 mL/(100 mL·min-1), MTT≤17.4 s, PS≥22.3 mL/(100 mL·min-1) and HAP≥43.3 mL/(100 mL·min-1) were all the independent risk factors for MVD formation (P<0.05)in patients with HCC. Conclusion MSCT perfusion imaging parameters could hint MVD existence in patients with HCC, which might help clinicians make appropriate management strategy, and improve prognosis of patients with HCC.

Key words: Hepatoma, Microvessel density, Multi-slice spiral computed tomography perfusion imaging, Impacting factors