肝细胞肝癌患者MRI特征在鉴别异常凝血酶原状态中的价值  

MRI signs for diagnosis of positive PIVKA-Ⅱin patients with hepatocellular carcinoma

作　　者：汪晟 郑永飞[1] 郑海澜[1] 王录兵[1] 黄丹江[1] WANG Sheng;ZHENG Yongfei;ZHENG Hailan;WANG Lubing;HUANG Danjiang(Department of Radiology,Taizhou First People's Hospital,Taizhou 318020,China)

机构地区：[1]台州市第一人民医院放射科,318020

出　　处：《浙江医学》2021年第2期157-160,179,共5页Zhejiang Medical Journal

基　　金：台州市第二批社会发展科技计划项目(20ywb68)。

摘　　要：目的探讨肝细胞肝癌患者MRI特征在鉴别异常凝血酶原(PIVKA-Ⅱ)阳性和阴性中的价值。方法回顾2018年1月至2020年3月台州市第一人民医院确诊的91例肝细胞肝癌患者的临床资料,根据PIVKA-Ⅱ水平分为PIVKA-Ⅱ阳性组45例(PIVKA-Ⅱ>32.01 mAU/ml)和PIVKA-Ⅱ阴性组46例(PIVKA-Ⅱ≤32.01 mAU/ml)。比较两组患者MRI特征和临床资料。应用单因素以及多因素logistic回归分析PIVKA-Ⅱ阳性肝癌患者MRI特征的影响因素。结果91例患者MRI增强均呈“快进快出”的强化模式。与PIVKA-Ⅱ阴性组比较,PIVKA-Ⅱ阳性组表现扩散系数(ADC)值更低,肿瘤更大,易表现为局部突出、弥散加权成像(DWI)靶征样改变,动脉期强化率更低(均P<0.05)。多因素logistic回归分析发现,ADC值(OR=0.989,95%CI:0.983~0.995,P<0.05),肿块大小(OR=1.130,95%CI:1.055~1.211,P<0.05),DWI靶征样改变(OR=5.904,95%CI:1.336~26.096,P<0.05)是PIVKA-Ⅱ阳性肝细胞肝癌MRI特征的影响因素。结论PIVKA-Ⅱ阳性与PIVKA-Ⅱ阴性肝细胞肝癌患者在MRI增强模式上表现一致,但其ADC值、肿块大小、DWI靶征样改变有助于鉴别PIVKA-Ⅱ阳性或阴性。Objective To evaluate the MRI features for differentiating positive protein induced by vitamin K absence or anatagonists-II(PIVKA-Ⅱ)in patients with hepatocellular carcinoma(HCC).Methods Clinical data of 91 HCC patients admitted to Taizhou First People's Hospital from January 2018 to March 2020 were retrospectively analyzed,including 79 males and 12 females,with an average age of 59.6 years.Among 79 patients there were 45 cases with positive PIVKA-Ⅱ(>32.01 mAU/ml),and 46 cases with negative PIVKA-Ⅱ(≤32.01 mAU/ml).The clinical and MRI features were compared between the two groups.Univariate and multivariate logistic regression were used to analyze the influencing factors of PIVKA-Ⅱpositive HCC.Results All patients showed"fast in and fast out"reinforcement way on MRI.Univariate regression analysis showed that compared with PIVKA-Ⅱnegative HCC,PIVKA-Ⅱpositive HCC had lower ADC value,larger tumor,lower arterial phase enhancement rate,and was more likely to have focal protrusion and DWI target signature change(all P<0.05).Multivariate regression analysis showed that the ADC value(OR=0.989,95%CI:0.983~0.995,P<0.05),and tumor size(OR=1.130,95%CI:1.055~1.211,P<0.05),DWI target signature change(OR=5.904,95%CI:1.336~26.096,P<0.05)were the influencing factors for PIVKA-Ⅱpositive in HCC patients.Conclusion PIVKA-II positive and negative HCC patients present the same dynamic MRI enhancement pattern,but the ADC value,tumor size and DWI target signature change are different between PIVKA-Ⅱpositive and negative HCC.

关 键 词：肝细胞肝癌 异常凝血酶原 MRI特征 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]