index were detected. Results For the examination of CT dynamic enhancement, there was no significant difference in the beginning time between the two groups(P>0.05),and nor the peak time (P>0.05). But there was a significant difference in the wash-out time between the two groups(P<0.05).There was a significant difference in the persistence time between the two groups(P<0.05). For FCM examination, there was a significant difference in the tumor cell fraction and proliferation index at S phase between group A and B (P<0.05). The aneuploid tumor cells were found in 15 HCC nodes of group A (15/28), but no aneuploid cells were found in group B. In all thirty five HCC tumor nodes,the correlation between enhanced persistence time and tumor cell proliferation index had statistical significance(P<0.05).Conclusion The investigation shows that there is an negative correlation between enhanced persistence time and tumor cell S phase proliferation index in HCC nodes. The enhanced persistence time may be related to the tumor malignancy at some degree. The shorter persistence time, the more malignant the tumor.
【Key words】 hepatocellular carcinoma; CT dynamic enhancement; DNA; flow cytometry
根据以往增强CT文献报道[1]，原发性肝细胞癌主要CT表现为：病灶“快速增强，快速衰减”，即造影剂“快进快退”，而良性肿瘤则表现为“快进慢退”。但是在工作实践中，我们发现部分原发性肝细胞癌在肝脏CT动态增强中亦表现为“快进慢退”。由于其各期增强表现形式与良性肿瘤相似，故设想可能与肿瘤生物学特性，即肿瘤细胞的DNA增殖水平有关。为此，本研究对比观察呈典型“快进快退”表现的原发性肝细胞肝癌28例与呈不典型“快进慢退”表现的原发性肝细胞型肝癌7例，并对各肿瘤组织行流式细胞术检测，探讨原发性肝细胞型肝癌的CT动态增强各期增强表现与其DNA增殖水平关系及其临床意义。
1 资料与方法
1.1 一般资料 选择2006年6月至2007年3月在我院进行肝脏CT动态增强检查的原发性肝细胞型肝癌患者35例，共计35个肿瘤，其中伴有门静脉癌栓4例，伴有门静脉癌栓4例;所有患者均有肝硬化背景，均无远处转移。根据动态增强CT检查表现分为典型组(A组)28例，即造影剂始退时间≤50 s的“快进快退”组;非典型组(B组)7例，即始退时间>50 s的“快进慢退”组。A组28例中男25例，女3例;年龄29～71岁，平均年龄(52±11)岁;肿瘤结节共计28个，右肝19个，左肝9个;直径为2.2～11.1 cm，平均直径(4.7±1.9)cm。B组7例中男6例，女1例;年龄44～62岁，平均年龄(53±6)岁;肿瘤结节共计7个，右肝5个，左肝2个;直径为2.1～3.3 cm，平均直径(2.7±0.4)cm。所有肝占位性病变患者CT动态增强后均在2周内行原发性肝癌根治术，手术新鲜标本立即送病理学检查及流式细胞术检查。
1.2 扫描方案 要求患者禁食至少12
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