Relationship Between Tumoral Vascularity With Doppler Sonography And MVD, Expression Of VEGF In Primary Hepatocarcinoma

PurposePrimary hepatocarcinoma(PHC ) is one of the most common malignancies in our country. It grows rapidly and can transfer in and out of the liver. The characteristic of its vascular distribution and blood supply are important in the diagnosis, therapy and prognosis of hepatocarcinoma. To study the blood of hepatic tumors with color Doppler flow image (CDFI), pulse wave Doppler(PW), color power angiography(CPA), the blood supply was reflected, hemodynamic parameters of hepatocarcinomas were compared to microvessel density(MVD) and the expression of vascular endothelial growth factor(VEGF) derived from immunohistochemistry by the characteristics of blood supply and their hemodynamics.The relationship between tumural vascularity with Doppler sonography and MVD, the expression of VEGF in hepatocarcinoma was investigated, so as to provide a objective evidence for the treatment and assessment of prognosis. Methods32 primary hepatocarcinoma (29HCC, 1mixed patterns and 2cholangiocarcinoma)were examined with CDFI, PW, CPA. The blood supply in peritumor and intratumor were observed and optimal images were stored in MO dies for analysis. 32 hepatocarcinomas were classified into three types: Small liver cancer(6cases), node liver cancer (18cases)and lump liver cancer(8cases) by diameter of hepatocarcinomas. According to metastasis in the Infer vena cava, portal vein and celiac lymph node, the hepatocarcinomas were categorized into two stages: 7 cases of metastasis stage, 25 cases of stage without metastasis. All cases, fasting for 12 hours,in supine or left lateral position, were examined with 2D grey-scale sonography and Doppler sonography.l.The size, outline and inner echogram of each hepatocarcinomas were observed. The maximum and the minimal diameters were measured in the image which could display hepatic tumors clearly, the average diameters were recorded. Infer vena cava(IVC), portal vein and the area next to great blood vessels were observed to detect cancer embolic and lymphatic metastasis.2. Peripheral and inter blood flows of 32 hepatic tumors were showed with CDFI. The angle was less than 30 degree between Doppler sample line and the blood flow, clear PW spectra were obtained. The pulsatile flows were checked and resistance index(RI) were measured. The value of RI corresponding the highest PSV were recorded.3. The blood supply in area of tumors was observed with CPA. According to the vascular shape and rich degree of the flow, the pattern of blood flow were categorized. Pattern I : There were peripheral and internal flows like spot. Pattern II: There were peripheral and internal flows like spot and line or with simple branches. Pattern III: There were rich peripheral and internal flows like tree branches and nets with complex branches.4. All the slices of tumors tissue specimens excised operatively were performed HE staing pathologic examine and immunmohistochemistry using anti- factor-VIII related antigen (VIII-RAg) polyclonal antibody and anti- vascular endothelial growth factor(VEGF) monoclonal antibody. The MVD were calculated separately and theexpression of VEGF of excised tumor were records. Results1. The pathological results of the 32 tumors excised showed that 29 cases were HCC, 1 case mixed patterns and 2 case cholangiocarcinoma.2. Immunohistochemically, the plasma of the vessel endothelial cell in cancerous tissue were positively stained with VIII-RAg, assessing the MVD were 36.87±16.79 respectively. Parts of membranes and plasmas of tumor cells of 20 cases expressed positively and the rate is 62.50 percent.3. 6 (18.75%) of 32 were displaying as CPA I with only dot-like blood flow signals in peritumor and intratumor; 18 (56.25%) cases were II with stripe, branch-shaped blood flow signals in peritumor and intratumor; 8 (25.00%) cases were III, displaying as tree branch blood flow signals in intratumor and surrounding vessels in peritumor with branches extending into; The MVD of the three grades were 21.74±7.44, 36.34+12.01, 49.43±21.94 respectively and there were significant differences between-groups.The MVD rised with the blood grades .The positive rates of VEGF of three grades is 50.00 percent, 72.22 percent and 50.00 percent respectively and there were no significant diffirence between-groups.4. Results using PW: There were 8 cases, 17 cases, 7 cases in Small liver cancer, node liver cancer and lump liver cancer respectively. The MVD of the three grades were 23.74±9.38, 35.54±11.30, 55.41+20.22 respectively. The RI of the three grades were 0.61±0.10, 0.71+0.12, 0.82±0.08 respectively and there were significant differences between-groups. The MVD and RI rised with diameter. The positive rates of VEGF of three grades is 62.50 percent, 58.82 percent and 71.43 percent respectively and there were no significant diffirence between-groups. The MVD of metastasis stage and stage without metastasis were 2.18+14.21, 53.94± 15.78 respectively. The RI of two stages were 0.68+0.12, 0.79+0.13 respectively. The positive rates of VEGF of two stages were 52.00% ^ 100% respectively. There were significant differences between the MVD, RI, the positive rates of VEGF of metastasis stage and stage without metastasis.5. The RI of VEGF-positive and VEGF-negative grades were 0.64±0.13, 0.75 ±0.11 respectively and there were significant differences between-groups. The MVD of VEGF-positive and VEGF-negative grade were 28.03+12.65, 42.28±17.24 respectively. The MVD of VEGF-positive grades were higher than those of VEGF-negative grade.6. There was a positive correlation between RI and MVD(r=0.520rP<0.05) Conclusions1. The blood flow grading by CPA rised with MVD and can reflect the angiogenesis activity of hepatic carcinoma to some extent.2. Hemodynamic parameters (RI) of hepatic carcinoma, MVD and the expression of VEGF have some correlations with diameter and metastasis of carcinoma. They maybe reflect the angiogenesis character of hepatocarcinoma from different angle.3. Doppler sonography of hepatocarcinoma can be used as a non-invasive method to evaluate the angiogenesis activity of hepatic carcinoma and can provide a objective evidence for the treatment and assessment of prognosis.