基于肝脏影像报告与数据系统的磁共振成像评估肝细胞癌磷脂酰肌醇蛋白聚糖-3表达的研究  

Study of magnetic resonance imaging based on liver imaging reporting and data system for evaluating phosphatidylinositol proteoglycan-3 expression in hepatocellular carcinoma

作　　者：孙伟 赵江涛 高珊珊 韩晶 盛若凡 曾蒙苏 Sun Wei;Zhao Jiangtao;Gao Shanshan;Han Jing;Sheng Ruofan;Zeng Mengsu(Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Medical Imaging,Shanghai 200032,China;Department of Pathology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital(Xiamen),Fudan University,Xiamen 361006,China)

机构地区：[1]复旦大学附属中山医院放射科,上海市影像医学研究所,上海200032 [2]复旦大学附属中山医院病理科,上海200032 [3]复旦大学附属中山医院厦门医院放射科,厦门361006

出　　处：《中华肝脏病杂志》2022年第8期866-872,共7页Chinese Journal of Hepatology

基　　金：福建省科技厅自然科学基金(青年创新)(2021D032);上海市“医苑新星”青年医学人才培养资助计划(沪卫人事[2020]087号);国家自然科学基金(91859107)。

摘　　要：目的明确基于肝脏影像报告与数据系统(LI-RADS)的磁共振成像(MRI)对肝细胞癌(HCC)中磷脂酰肌醇蛋白聚糖-3(GPC3)表达的诊断价值。方法回顾性分析及比较95例GPC3表达阳性(+)及40例表达阴性(-)HCC患者的临床、病理资料及基于2018版LI-RADS的MRI图像特征,并通过多因素logistic回归分析确定GPC3表达的主要预测指标,进一步采用受试者操作特征曲线检验明确临床-影像联合模型预测GPC3表达的诊断效能。计数资料采用χ^(2)检验或Fisher精确概率法进行比较;计量资料采用独立样本t检验或Mann-Whitney U检验。结果GPC3(+)与GPC3(-)组HCC的甲胎蛋白(AFP)水平(χ^(2)=31.814,P<0.0001)、包膜强化(χ^(2)=4.108,P=0.043)、晕状强化(χ^(2)=4.847,P=0.028)MRI特征,及病灶表观弥散系数(ADC)(t=2.552,P=0.0118)的差异存在统计学意义。多因素回归分析显示AFP>20μg/L(OR=9.358,P<0.0001)及ADC≤1.404×10^(-3) mm^(2)/s(OR=1.003,P=0.017)为HCC中GPC3表达的独立预测指标;两者联合模型诊断GPC3(+)HCC的曲线下面积值为0.810,其诊断灵敏度和特异度分别为76.8%和77.5%。结论AFP>20μg/L及ADC≤1.404×10^(-3) mm^(2)/s可提示HCC中GPC3表达,两者联合诊断指标可为临床提供简便、有效的无创性诊断手段。Objective To clarify the diagnostic value of magnetic resonance imaging based on liver imaging reporting and data system(LI-RADS)for phosphatidylinositol proteoglycan-3(GPC3)expression in hepatocellular carcinoma(HCC).Methods Clinical and pathological data of 95 HCC cases with positive GPC3 expression(+)and 40 HCC cases with negative GPC3 expression(-)were retrospectively analyzed,and their MRI image features based on the 2018 version of LI-RADS were compared.Multivariate logistic regression analysis was used to determine the main predictors of GPC3 expression.Receiver operating characteristic curve was used further to determine the diagnostic efficacy of combined clinical imaging model to predict GPC3 expression.Enumeration data were compared with χ^(2) test or Fisher's exact test.Measurement data were compared using independent samples t-test or Mann-Whitney U-test.Results There were statistically significant differences between HCC in GPC3(+)and GPC3(-)group at alpha-fetoprotein(AFP)levels(χ^(2)=31.814,P<0.0001),and MRI features:capsular enhacement(χ^(2)=4.108,P=0.043),halo type enhancement(χ^(2)=4.847,P=0.028),and lesion apparent dispersion coefficient(ADC)(t=2.552,P=0.0118).Multivariate regression analysis showed that AFP>20μg/L(OR=9.358,P<0.0001)and ADC≤1.404×10^(-3) mm^(2)/s(OR=1.003,P=0.017)were independent predictors for GPC3 expression in HCC.The combined model and the area under the curve value for the diagnosis of GPC3(+)in HCC was 0.810,and its diagnostic sensitivity and specificity were 76.8%and 77.5%,respectively.Conclusion AFP>20μg/L and ADC≤1.404×10^(-3) mm^(2)/s may indicate the expression of GPC3 in HCC,and the combination of the two diagnostic indicators can provide a simple and effective non-invasive diagnostic method for clinical practice.

关 键 词：肝细胞癌 磁共振成像 磷脂酰肌醇蛋白聚糖-3 肝脏影像报告与数据系统 

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]