Correlative Study On MRI Findings With MVD And Expression Of VEGF In Hilar Cholangiocarcinoma

Objective To analysis the correlation of MR findings with MVD and expression of VEGF in hilar cholangiocarcinoma, and to explore the value of MR Imaging in estimating the degree of neoangiogenesis, biologic behavior and prognosis of hilar cholangiocarcinoma.Materials and methods magnetic resonance (MR) imaging of hilar cholangiocarcinoma was performed in Twenty-eight patients (aged 43～75 years, mean age 56.23 years) .In all selected patients, 15 cases received radical operation and the others received palliative operation. Experiment group: the normal tissues were from 9 cases of hepatic carcinoma; the para-tumor tissues were from the incising margin of radical operation and tumor tissues were from 28 cases operative specimens. all lesions were verified by pathological and immunochemical methods, including 16 cases of tubular adenocarcinoma, 8 cases of non-differentiated adenocarcinoma, 3 cases of mucinous adenocarcinoma, 1 cases of mastoid adenocarcinoma. The correlation of MR findings and dynamic contrast-enhanced MR Imaging△SI with MVD and expression of VEGF in hilar cholangiocarcinoma were analyzed.Results (1)MR imaging findings: Hilar mass, dilatation of intrahepatic ducts and discontinuniy of hilar biliary ducts were seen in all cases, including 20 infiltrating, 7 exophytic and 1 intraluminal lesions. All the tumors were hypintense on T1-weighted spin-echo images. Most of the tumors presented iso- or mild hyper-intensity on T2-weighted images. According the different types of dynamic contrast-enhanced MR Imaging: 18 cases of I type,6 cases of II type,3 cases of III type and 1 cases of IV type. Spiral-like arteries were demonstrated in 4 cases and located strait in 2 cases on 3D-DCE-MRA during arterial phase. Portal vein was involved in 18 cases, presenting as infiltration, encasement or occlusion of the vein.(2)MVD and VEGF expression detected by immunochemical methods: The MVD in tumor tissue and para-tumor tissue was significantly higher than in normal tissue(P<0.01).In 52 cases of normal tissues and tumor tissues, VEGF positive expression were found in 32 cases, and the mean MVD was 33.15±8.29; VEGF negative expression were found in 20 cases, and the mean MVD was 17.42±11.13. The difference between MVD,VEGF expression and histological type had no statistical significance (P>0.05).(3)MVD in the groups of invasion and metastases in the lesions were higher than non-metastases (P<0.05); but their relation to the morphologic classification according to growth pattern were not significant (P>0.05) .There was correlation between MVD and dynamic enhancement pattern (P<0.05) ; the enhancement rate (△SI) of the early-phase signal intensity was significantly correlated with MVD and VEGF.Conclusions (1)MR, including plain MR, MRCP , dynamic contrast-enhanced MRI and 3D-DCE-MRA ,can give more useful information about the diagnosis and preoperative evaluation in hilar cholangiocarcinoma.(2)hilar cholangiocarcinoma progression was angiogenesis-correlation, and higher MVD and VEGF expression indicated poor prognosis.(3)MR imaging findings and dynamic contrast-enhanced MR△SI is of potential value for estimating the degree of tumor angiogenesis, biologic behavior and prognosis of hilar cholangiocarcinoma. In some sense, MRI may estimate the degree of tumor angiogenesis, biologic behavior and prognosis of hilar cholangiocarcinoma.