基于钆塞酸二钠增强MRI的临床评分模型预测肝细胞癌微血管侵犯的多中心研究  

A clinical scoring model based on Gd-EOB-DTPA enhanced MRI predicting microvascular invasion in hepatocellular carcinoma:a multicenter study

作　　者：张坤 张天奇 谢双双[1] 张磊[2] 何刊[2] 李文萃 叶兆祥 张惠茅[2] 沈文[1] Zhang Kun;Zhang Tianqi;Xie Shuangshuang;Zhang Lei;He Kan;Li Wencui;Ye Zhaoxiang;Zhang Huimao;Shen Wen(Department of Radiology,Tianjin First Central Hospital,Tianjin Institute of Imaging Medicine,Tianjin 300192,China;Department of Radiology,the First Hospital of Jilin University,Changchun 130021,China;Department of Radiology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin′s Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China)

机构地区：[1]天津市第一中心医院放射科天津市影像医学研究所,天津300192 [2]吉林大学第一医院放射科,长春130021 [3]天津医科大学肿瘤医院放射科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心,天津300060

出　　处：《中华放射学杂志》2022年第10期1115-1120,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(81901710);天津市卫生健康科技项目青年人才项目(TJWJ2021QN011,QN20024);天津市医学重点学科(专科)建设项目(TJYXZDXK-041A)。

摘　　要：目的建立基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI的术前预测肝细胞癌(HCC)微血管侵犯(MVI)的评分模型,并验证其效能。方法回顾性收集2014年1月至2020年12月天津市第一中心医院和吉林大学第一医院经病理证实的251例HCC患者为建模队列,回顾性收集同期天津医科大学肿瘤医院的57例HCC患者作为独立验证队列。根据病理结果分为MVI阳性组和MVI阴性组。测量肿瘤最大径和表观扩散系数(ADC)值,基于Gd-EOB-DTPA增强MRI,观察肿瘤形态、瘤周强化、肝胆期瘤周低信号(PTLI)、包膜、瘤内动脉、瘤内脂肪、瘤内出血、瘤内坏死。采用χ2检验或独立样本t检验进行单因素分析,采用多因素logistic分析在建模队列中获得MVI的独立危险因素,并根据权重值为每个因素分配分值,建立术前预测MVI的评分模型。采用受试者操作特征(ROC)曲线确定评分阈值,并在独立验证队列中验证该评分模型预测MVI的效能。结果建模队列中MVI阳性组98例、MVI阴性组153例,验证队列中MVI阳性组16例、MVI阴性组41例。经logistic分析,肿瘤最大径>3.66 cm(OR 3.654,95%CI 1.902~7.018)、肝胆期PTLI(OR 9.235,95%CI 4.833~16.896)和包膜不完整(OR 6.266,95%CI 1.993~9.345)是HCC发生MVI的独立危险因素,根据权重值,分别赋分值为3、4、2分,总分为0~9分。在验证队列中,ROC曲线分析显示,评分模型的曲线下面积为0.918(95%CI 0.815~0.974,P=0.001),以评分>4分为阈值时,模型预测MVI的准确度、灵敏度、特异度分别为84.2%、81.3%、85.4%。结论基于Gd-EOB-DTPA增强MRI的评分模型为术前预测HCC病灶MVI提供了便捷、可靠的方法。Objective To establish a clinical diagnostic scoring model for preoperative predicting hepatocellular carcinoma(HCC)microvascular invasion(MVI)based on gadolinium-ethoxybenzyl-diethylenetriamine pentacetic acid(Gd-EOB-DTPA)enhanced MRI,and verify its effectiveness.Methods From January 2014 to December 2020,a total of 251 cases with pathologically confirmed HCC from Tianjin First Central Hospital and Jilin University First Hospital were retrospectively collected to serve as the training set,while 57 HCC patients from Tianjin Medical University Cancer Hospital were recruited as an independent external validation set.The HCC patients were divided into MVI positive and MVI negative groups according to the pathological results.The tumor maximum diameters and apparent diffusion coefficient(ADC)values were measured.On the Gd-EOB-DTPA MRI images,tumor morphology,peritumoral enhancement,peritumoral low intensity(PTLI),capsule,intratumoral artery,intratumoral fat,intratumoral hemorrhage,and intratumoral necrosis were observed.Univariate analysis was performed using theχ2 test or the independent sample t-test.The independent risk factors associated with MVI were obtained in the training set using a multivariate logistic analysis.Points were assigned to each factor according to the weight value to establish a preoperative score model for predicting MVI.The receiver operating characteristic(ROC)curve was used to determine the score threshold and to verify the efficacy of this scoring model in predicting MVI in the independent external validation set.Results The training set obtained 98 patients in the MVI positive group and 153 patients in the MVI negative group,while the external validation set obtained 16 patients in the MVI positive group and 41 patients in the MVI negative group.According to logistic analysis,tumor maximum diameter>3.66 cm(OR 3.654,95%CI 1.902-7.018),hepatobiliary PTLI(OR 9.235,95%CI 4.833-16.896)and incomplete capsule(OR 6.266,95%CI 1.993-9.345)were independent risk factors for MVI in HCC,which were ass

关 键 词：癌 肝细胞 磁共振成像 微血管侵犯 评分模型 

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]