术前超声预测肝细胞癌微血管侵犯的价值  

The value of preoperative ultrasound in predicting microvascular invasion of hepatocellular carcinoma

作　　者：田婷[1] 姜琴[1] 商利 廖锦堂[1] 周建华[2] Tian Ting;Jiang Qin;Shang Li;Liao Jintang;Zhou Jianhua(Department of Ultrasound, Xiangya Hospital, Central South University, Changsha 410008, China;Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, China)

机构地区：[1]中南大学湘雅医院超声影像科,长沙410008 [2]中南大学湘雅医院病理科,长沙410008

出　　处：《中华超声影像学杂志》2019年第4期323-329,共7页Chinese Journal of Ultrasonography

摘　　要：目的分析肝细胞癌患者的超声影像学特征和临床特点,以探讨术前超声预测肝细胞癌微血管侵犯的价值。方法回顾性分析中南大学湘雅医院2016年1月至2018年7月就诊的171例肝细胞癌患者。对可能与微血管侵犯有关的超声影像特征及临床资料进行单因素及多因素分析,并评估独立危险因素的诊断效能。绘制ROC曲线,比较联合诊断模式1、模式2、瘤周强化及肿瘤边缘的诊断效能。结果单因素分析结果显示,血清甲胎蛋白水平、肿瘤大小、瘤周低回声晕环、瘤周强化、肿瘤边缘与微血管侵犯有关,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,瘤周强化和肿瘤边缘不光滑是预测微血管侵犯的独立危险因素。瘤周强化和肿瘤边缘不光滑的敏感性、特异性、阳性预测值和阴性预测值分别为51.4%对83.8%、81.4%对48.5%、67.9%对55.4%、68.7%对79.7%。模式1、模式2、瘤周强化及肿瘤边缘的AUC分别为0.741、0.716、0.664、0.661。结论术前超声对预测肝细胞癌微血管侵犯有一定的价值。瘤周强化和肿瘤边缘不光滑是预测肝细胞癌微血管侵犯的独立危险因素。超声用于术前预测肝细胞癌微血管侵犯时还需结合肿瘤大小、瘤周低回声晕环及血清甲胎蛋白水平。Objective To analyze the ultrasound imaging features and clinical characteristics in patients with hepatocellular carcinoma (HCC), and assess the value of ultrasound in preoperatively predicting microvascular invasion(MVI) of HCC. Methods One hundred and seventy-one patients with HCC were retrospectively collected from January 2016 to July 2018. The ultrasound imaging features and clinical data that may be associated with MVI were analyzed by univariate and multivariate analyses, and the diagnostic efficacy of independent risk factors was further evaluated. ROC curves were plotted to compare the diagnostic efficacy of combined diagnostic mode 1, mode 2, peritumoral enhancement, and tumor margin. Results Univariate analysis showed that the serum AFP level, tumor size, peritumoral hypoechoic halo, peritumoral enhancement, and tumor margin were significantly correlated with MVI (P<0.05). Multivariate logistic regression analysis further indicated that peritumoral enhancement and non-smooth tumor margin were the independent risk factors for predicting MVI. The sensitivity, specificity, positive predictive value and negative predictive value of peritumoral enhancement and non-smooth tumor margin were 51.4% vs 83.8%, 81.4% vs 48.5%, 67.9% vs 55.4%, and 68.7% vs 79.7%, respectively. The AUC of mode 1, mode 2, peritumoral enhancement and tumor margin were 0.741, 0.716, 0.664, and 0.661, respectively. Conclusions Preoperative ultrasound is valuable in predicting MVI of HCC. Peritumoral enhancement and non-smooth tumor margins are independent risk factors for predicting MVI of HCC. Tumor size, hypoechoic halo around the tumor, and serum AFP levels must be taken into account when predicting MVI of HCC by using preoperative ultrasound.

关 键 词：超声检查 肝细胞癌 超声造影 微血管侵犯 危险因素 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]