IVIM-DWI多参数MRI对肝癌微血管侵犯的预测价值  

Predictive value of IVIM-DWI multi-parameter MRI in microvessel invasion of hepatocellular carcinoma

作　　者：马依迪丽·尼加提 王劲[2] 买合米提江·达莫拉 张瑶[2] 米日古丽·达毛拉 Mayidili·Nijiati;Wang Jin;Maihemitijiang·Damola;Zhang Yao;Miriguli·Damaola(Department of Imaging,the First People's Hospital of Kashgar of Xinjiang Uygur Autonomous Region,Kashgar 844000,China;Department of Radiology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]新疆维吾尔自治区喀什地区第一人民医院影像科,844000 [2]中山大学附属第三医院放射科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2022年第1期39-43,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金重大研究计划项目(91959118)。

摘　　要：目的探讨体素内不相干运动-扩散加权成像(IVIM-DWI)多参数MRI对肝细胞癌(肝癌)微血管侵犯(MVI)的预测价值。方法回顾性分析2014年3月至2020年5月中山大学附属第三医院96例肝癌患者临床影像学资料。患者均签署知情同意书,符合医学伦理学规定。其中男81例,女15例;平均年龄(51±3)岁。根据病理结果将患者分为MVI阳性组(33例)和MVI阴性组(63例)。所有患者术前1个月内均行腹部增强MRI及IVIM-DWI检查。常规MRI图像评估包括包膜完整、肿瘤晕征、马赛克征等肝癌影像学特征。IVIM-DWI测量肿瘤表观扩散系数(ADC)值、假表观扩散系数(D*)值,灌注分数(F)值等。MVI阳性患者影像学特征分析采用t检验或χ^(2)检验,Logistic回归分析影像学指标与MVI的相关性,并采用诊断试验评估影像学指标对MVI的预测价值。结果 MVI阳性患者肿瘤马赛克征、肿瘤晕征出现率较高(χ^(2)=15.492,9.412;P<0.05),ADC及F值明显降低,而D*值明显升高(t=-2.252,-3.034,2.977;P<0.05)。Logistic多因素回归分析显示,马赛克征、肿瘤晕征、F值是肝癌MVI发生的独立影响因素(HR=5.589,5.408,0.324;P<0.05)。马赛克征、肿瘤晕征、F值预测肝癌MVI的敏感度分别为0.42、0.79、0.79,特异度分别为0.94、0.91、0.49,三者联合预测MVI发生的特异度升高至0.97。结论 IVIM的多参数MRI对肝癌MVI发生具有一定的预测价值,其中马赛克征、肿瘤晕征、F值三者预测联合肝癌MVI发生具有较高的特异度。Objective To evaluate the predictive value of intra-voxel incoherent motion diffusion-weighted imaging (IVIM-DWI) multi-parameter MRI in microvessel invasion (MVI) of hepatocellular carcinoma (HCC).Methods Clinical and imaging data of 96 patients with HCC admitted to the Third Affiliated Hospital of Sun Yat-sen University from March 2014 to May 2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,81 patients were male and 15 female,aged (51±3) years old on average.According to pathological results,all patients were divided into the positive MVI group (n=33) and negative MVI group (n=63).All the patients received abdominal contrast-enhanced MRI and IVIM-DWI within preoperative 1 month.Imaging features of HCC,such as capsule integrity,tumor halo sign and mosaic sign,etc.were assessed by conventional MRI.The tumor apparent diffusion coefficient (ADC),pseudo apparent diffusion coefficient (D*) and perfusion fraction (F) values were measured by IVIM-DWI.The imaging features of positive MVI patients were analyzed by t test or Chi-square test.The correlation between imaging parameters and MVI was determined by Logistic regression analysis.The predictive value of imaging parameters on MVI was assessed by diagnostic test.Results In positive MVI patients,the incidence of tumor mosaic sign and tumor halo sign was significantly increased (χ2=15.492,9.412;P<0.05),the ADC and F values were remarkably decreased,whereas the D* value was significantly elevated (t=-2.252,-3.034,2.977;P<0.05).Multivariate Logistic regression analysis demonstrated that mosaic sign,tumor halo sign and F value were the independent influencing factors of MVI in HCC (HR=5.589,5.408,0.324;P<0.05).The sensitivity and specificity of mosaic sign,tumor halo sign and F value in predicting MVI were 0.42,0.79,0.79,and 0.94,0.91,0.49,respectively.The specificity of these three signs combined in predicting MVI was increased to 0.97.Conclusions Multi-parameter MRI

关 键 词：癌 肝细胞 微血管侵犯 磁共振成像 

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]