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Study of Correlation between the CT Features and Lens Culinaris Agglutinin-reactive a-Fetoprotein (AFP-L3%) in Hepatocellular Carcinoma

Author: ChenZuHua
Tutor: YuRiSheng
School: Zhejiang University
Course: Medical Imaging and Nuclear Medicine
Keywords: Hepatocellular carcinoma Lens culinaris agglutinin-reactive a-Fetoprotein(AFP-L3) X-ray computed Tomography
CLC: R735.7
Type: Master's thesis
Year: 2011
Downloads: 50
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Objective:The aim of this study was to evaluate the correlation between the CT features and Lens culinaris agglutinin-reactive a-Fetoprotein(AFP-L3%) in Hepatocellular carcinoma (HCC), which sought the imaging basis for HCC patients with the high ratio of AFP-L3 (AFP-L3%) who were poor prognosis, to help the choice in the treatment of HCC. And the CT features were preliminarily explored in the HCC who had less than 200ng of AFP concentration in the AFP-L3 of 10% or higher.Materials and Methods:151 cases of HCC who were examinated AFP-L3 and MSCT (multidetector CT, MSCT) in 15 days before treatment in our hospital were regarded as research object. AFP-L3 of 10% or higher were judged to be positive group and less than 10% were negative group. AFP-L3 was acquired by lectin-affinity micro centrifuge column separation of AFP. AFP and AFP-L3 were detected by chemiluminescence and calculated AFP-L3 percentage of total AFP. On the multi-phase enhanced CT scan, CT features were analyzed in the general type, lesions’number (multiple lesions, namely 2 or more lesions), focus’boundary, degree of enhancement in arterial phase, portal or hepatic vein invasion, intrahepatic and external metastasis of HCC. The CT features were analysed in the HCC who were less than 200ug of AFP concentration in AFP-L3% positive group, and the CT features of HCC who were grouped according to the AFP concentration were contrast study. Meanwhile, the correlation among AFP concentration, AFP-L3% and general type of HCC were analysed. The statistical ways were adopted according to corresponding data.Results:96 patients(63.6%) with AFP-L3% positive group and 55 patients (36.4%) with negative group were found in 151 cases of HCC. AFP mean concentration 10894ug/L of positive group was significantly higher than mean concentration 5178ug/L of negative group (Z=-2.840, P<0.01). There were 23 cases (24%) with AFP concentration of less than 200ug/L, one case with AFP negative (<20ug/L) in the positive group.CT findings of HCC:there were found massive type in 68 patients (45%), nodular type in 42 cases (27.8%), diffuse type in 22 patients (14.6%), small HCC in 19 patients (12.6%). Multiple lesions in 75 cases (49.7%), single focus in 76cases (50.3%), unclear or irregular edge of lesions in 96 cases (63.6%), clear or regular edge in 55 cases (36.4%), uneven density in 98 cases (64.9%) and uniform density in 53 cases (35.1%) were showed on CT. Mild enhancement in 43 cases (28.5%), moderate enhancement 69 cases (45.7%), and marked enhancement in 39 cases (25.8%) were displayed in arterial phase. Vascular invasion in 72 cases (47.7%), intrahepatic and external metastasis in 30 patients (19.9%) were diagnosed.The correlation analysis between CT features and AFP-L3% in HCC:positive rate (55.2%) of massive type in the positive group was higher than (27.3%) of the negative group(X2=11.024, p<0.01) and positive rate (5.2%) of small HCC was significantly lower than 25.5% of the negative group (X 2=18.201, p<0.001), but positive rate of nodular type, diffuse type between the two groups were not statistically significant (p>0.05). Positive rate(53%) of multiple lesions was high than 43.6% of negative group, but the two groups were not statistically significant.76%、79% of unclear or irregular edge and uneven density in the positive group were significantly higher than 42%、40% of the negative group (p<0.001). Enhanced degree in arterial phase was statistically significant than negative groups(p<0.05); mild (31%) and moderate (49%) enhancement were showed in the positive group, and moderate (40%) and marked (36.4%) enhancement were displayed in the negative group. Vascular invasion(57.3%) and intrahepatic and external metastasis(27.1%) were significantly higher than 30.9%、7.3% of negative groups (p<0.001).The CT findings of 23 cases who were less than 200ug of AFP concentration in the positive group:nodular type in 11 patients (47.8%) was found. Secondly, massive type in 9 cases (39.1%) were showed, which were some difference with the positive rate of overall in the postive group, diffuse type and small HCC were rare, together 3 cases; 51.2%(12 cases) in multiple lesions was roughly similar with 53% of the positive group; Unclear or irregular edge and uneven density were showed in 17 cases (73.9%) and 16 cases(69.6%) respectively, but which were slightly lower than 76%.79%of positive group; Enhanced degree in arterial phase was roughly similar with that of the positive group, light and moderate enhancement were showed in 9 cases (39.1%) respectively; vascular invasion in 10 cases (43.5%) and intrahepatic and external metastasis 3 patients (13%) were lower than 57.3%,27.1% of positive group. Multiple lesions in 6 cases (6/10) vascular invasion in 5 cases (5/10) and marked enhancement in 4 cases(4/10) in10 cases of HCC with AFP between 100 and 200 were higher than 5 cases (5/12),4 cases (4/12), 1 case (1/12) of 12 cases with AFP between 20 and 100, while the latter had high incidence of nodular type HCC. CT findings of HCC with negative of AFP (n=1) in the positive group showed large tumor, unclear boundary, uneven density, uneven medium enhancement in arterial phase and portal vein infringement.The correlation analysis among the AFP, AFP-L3% and CT general type of HCC demonstrated that AFP, AFP-L3% in massive type, diffuse type, nodular type and small HCC were significant difference between them (p<0.001).Conclusion:This study demonstrated that there existed the correlation between the CT features and AFP-L3% in HCC. AFP-L3% positive HCC had large volume of tumor, invasive growth, easy to violate of blood vessels, or even extrabepatic metastasis etc malignant features on imaging, which prompted poor prognosis. Meanwhile, AFP concentration and AFP-L3% were significantly increased, which prompted the possibility of massive type or diffuse type HCC, on the contrary, which hinted the possibility of nodular type or small HCC on imaging examination.The CT malignant features of HCC with AFP less than 200ng in the positive group were less than that of the positive group, and showed that malignancy of HCC was relatively higher as the rise of AFP in the positive group. Therefore, imaging examination combining with the detection of AFP-L3% can help better the judgment of HCC prognosis and curative effect, provide the basis for clinical therapeutic choice.

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