表观扩散系数和肝细胞肝癌组织学病理分级的相关性分析  

A study on the correlation between apparent diffusion coefficient and histopathological grade of hepatocellular carcinoma

作　　者：查晓锋 王长耿 郭嘉菁 曹波[2] 肖慧 ZHA Xiaofeng;WANG Changgeng;GUO Jiajing;CAO Bo;XIAO Hui(Department of Radiology,the 900th Hospital of Joint Logistic Support Force,Fuzhou 350025,China)

机构地区：[1]联勤保障部队第九〇〇医院放射诊断科,福州350025 [2]南京医科大学第二附属医院医学影像科

出　　处：《功能与分子医学影像学（电子版）》2020年第3期1882-1887,共6页Functional and Molecular Medical Imaging(Electronic Edition)

摘　　要：目的应用MRI表观扩散系数来评估肝细胞肝癌Edmondson-Steiner病理分级之间的相关性分析。方法收集经病理证实为肝细胞肝癌(HCC)的85例患者手术前的MRI影像学资料,记录表观弥散系数(ADC)的平均值及最小值,比较不同病理分化程度HCC瘤内平均ADC值和最小ADC值的差异;分析平均ADC值和最小ADC值与病理等级的相关性,并采用受试者工作特征曲线(ROC)分析各指标评价HCC病理分级的诊断效能。结果不同病理分化程度的HCC瘤内平均ADC值和最小ADC值的差异具有统计学意义(P<0.05);肿瘤的平均ADC值、最小ADC值与Edmondson-Steiner病理分级均呈负相关性(|rs|=0.53,P<0.001)、(|rs|=0.55,P<0.001),平均ADC值诊断低分化HCC的敏感性为89.47﹪,特异性为57.58﹪,约登指数为0.41,AUC为0.77;最小ADC值诊断低分化HCC的敏感性为78.95﹪,特异性为74.24﹪,约登指数为0.53,AUC为0.79。二者联合诊断低分化HCC的敏感性为94.74﹪,特异性为59.09﹪,约登指数为0.54,AUC为0.81,但三者对诊断低分化肝癌的诊断效能差异均无统计学意义(P>0.05)。结论HCC的Edmondson-Steine分级与平均ADC值及最小ADC值存在中度负相关性,ADC值可以作为评估HCC病理分级的良好生物学指标。Objective To evaluate the correlation between MRI apparent diffusion coefficient and Edmondson-Steiner pathological grade of hepatocellular carcinoma.Methods The preoperative MRI data of 85 patients with pathologically confirmed hepatocellular carcinoma were collected.The average and minimum values of ADC were measured,and the overall and pairwise comparisons between groups were performed with One-way ANOVA and LSD.The correlation between average ADC value,minimum ADC value and Edmondson-Steiner pathological grade was evaluated using Spearman correlation coefficient,and the diagnostic performance of HCC pathological grade was evaluated by receiver working characteristic curve(ROC)analysis.Results There were significant differences between groups in the average and minimum ADC(P<0.05).Both the average ADC value and the minimum ADC value were negatively correlated with pathological grade(|rs|=0.53,P<0.001 and|rs|=0.55,P=0.000 respectively).The sensitivity,specificity and Yoden index of average ADC value in the diagnosis of poorly differentiated hepatocellular carcinoma were 89.47﹪,57.58﹪and 0.41,respectively.The AUC was 0.81.Those of the minimum ADC value was 78.95﹪,74.24﹪,and 0.53 with an AUC of 0.79.Combining these two resulted in the sensitivity,specificity and Yoden index for the diagnosis of poorly differentiated HCC of 94.74﹪,59.09﹪and 0.54 respectively,with an AUC of 0.81.There was no significant difference among the three groups in the diagnosis of poorly differentiated liver cancer(P>0.05).Conclusions There is a strong negative correlation between Edmondson-Steine grade and average and minimum ADC value.ADC value can be used as a good biological index to evaluate the pathological grade of hepatocellular carcinoma.

关 键 词：肝细胞肝癌 组织学分级 弥散加权成像 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]