Aspectos de imagem do carcinoma hepatocelular: associação com os graus histológicos de diferenciação
Data
2022-03-31
Autores
Bordão, Lurymi Takashi 
Orientadores
Silva, Ivonete Sandra de Sousa
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: com a redução de biópsia na avaliação do grau histológico de diferenciação do carcinoma hepatocelular (CHC), aspectos radiológicos que predizem os achados histológicos podem preencher essa lacuna Objetivo: Associar os achados radiológicos vistos em exames de imagem trifásicos com o grau histológico de diferenciação do CHC Método: foram estudados, retrospectivamente, portadores de CHC que tivessem exames de Tomografia Computadorizada (TC) ou Ressonância Magnética (RM) e de material anatomopatológico com no máximo 06 meses de intervalo entre eles, e sem tratamento locorregional. O material anatomopatológico consistiu de biópsias por punção guiadas por ultrassom, peças cirúrgicas e explantes de fígado que foram revisados por um único patologista. A avaliação quanto ao grau de diferenciação foi baseada na classificação de Edmondson-Steiner. A avaliação radiológica foi realizada de forma independente por dois radiologistas que formularam uma avaliação consensual final. Os aspectos de imagem avaliados foram aspecto do nódulo, hiperrealce na fase arterial (wash-in), lavagem não periférica (wash-out), nódulo em nódulo, invasão vascular, sangramento intratumoral, cápsula fibrosa/ pseudocápsula, gordura intratumoral, realce em coroa, densidade, calcificação, realce anelar, intensidade de sinal em T1, intensidade de sinal em T2, valor do coeficiente de difusão aparente (ADC) e restrição a difusão. A análise estatística incluiu o teste qui-quadrado ou exato de Fischer quando apropriado e teste t de Student. Resultados: Foram incluídos no estudo 42 pacientes e 48 nódulos no total. O grau de diferenciação mais comum foi o grau 2 em 22 nódulos (46%), seguidos do grau 3, 1 e 4 com 18 (38%),07 (14%) e 1 (2%) respectivamente. Houve associação entre o grau de diferenciação e o ADC, na proporção decrescente do grau 1 para o grau 2, 3 e 4, porém os demais aspectos de imagem não se associaram com a histologia. Conclusão: o estudo mostrou que nódulos com maior ADC são mais bem diferenciados.
Introduction: Considering the reduction of biopsy in the evaluation the histological degree of differentiation of hepatocellular carcinoma (HCC), radiological features that predict histological findings can fill this gap. Objective: To associate the radiological findings seen in triphasic imaging exams with the histological degree of differentiation of the HCC Method: were retrospectively studied patients with HCC who had Computed Tomography (CT) or Magnetic Resonance (MRI) exams and anatomopathological material with a maximum interval of 06 months between them, and without locoregional treatment. The anatomopathological material consisted of ultrasound guided punch biopsies, surgical specimens and liver explants that were reviewed by a single pathologist. The assessment regarding the degree of differentiation was based on the Edmondson-Steiner classification. The radiological assessment was performed independently by two radiologists who formulated a final consensual assessment. The radiological aspects evaluated were nodule appearance, hyperenhancement in the arterial phase (wash-in), non-peripheral washing (wash-out), nodule in nodule, vascular invasion, intratumoral bleeding, fibrous capsule/pseudocapsule, intratumoral fat, crown enhancement, density, calcification, ring enhancement, signal strength at T1, signal strength at T2, apparent diffusion coefficient (ADC) value and diffusion restriction. Statistical analysis included chi-square or Fisher's exact test when appropriate and Student's t test. Results: Forty-two patients and 48 nodules in total were included in the study. The most common grade of differentiation was grade 2 with 22 nodules (46%), followed by grade 3, 1 and 4 with 18 (38%),07 (14%) and 1 (2%) respectively. There was an association between the degree of differentiation and ADC, in a decreasing proportion from grade 1 to grade 2, 3 and 4, but the other radiological aspects were not associated with histology. Conclusion: the study showed that nodules with higher ADC are better differentiated.
Introduction: Considering the reduction of biopsy in the evaluation the histological degree of differentiation of hepatocellular carcinoma (HCC), radiological features that predict histological findings can fill this gap. Objective: To associate the radiological findings seen in triphasic imaging exams with the histological degree of differentiation of the HCC Method: were retrospectively studied patients with HCC who had Computed Tomography (CT) or Magnetic Resonance (MRI) exams and anatomopathological material with a maximum interval of 06 months between them, and without locoregional treatment. The anatomopathological material consisted of ultrasound guided punch biopsies, surgical specimens and liver explants that were reviewed by a single pathologist. The assessment regarding the degree of differentiation was based on the Edmondson-Steiner classification. The radiological assessment was performed independently by two radiologists who formulated a final consensual assessment. The radiological aspects evaluated were nodule appearance, hyperenhancement in the arterial phase (wash-in), non-peripheral washing (wash-out), nodule in nodule, vascular invasion, intratumoral bleeding, fibrous capsule/pseudocapsule, intratumoral fat, crown enhancement, density, calcification, ring enhancement, signal strength at T1, signal strength at T2, apparent diffusion coefficient (ADC) value and diffusion restriction. Statistical analysis included chi-square or Fisher's exact test when appropriate and Student's t test. Results: Forty-two patients and 48 nodules in total were included in the study. The most common grade of differentiation was grade 2 with 22 nodules (46%), followed by grade 3, 1 and 4 with 18 (38%),07 (14%) and 1 (2%) respectively. There was an association between the degree of differentiation and ADC, in a decreasing proportion from grade 1 to grade 2, 3 and 4, but the other radiological aspects were not associated with histology. Conclusion: the study showed that nodules with higher ADC are better differentiated.