钆塞酸二钠增强MRI T_(1)mapping评价肝细胞癌病理分级的价值  

VALUE OF GD-EOB-DTPA-ENHANCED MRI T_(1)MAPPING IN EVALUATING THE PATHOLOGICAL GRADE OF HEPATOCELLULAR CARCINOMA

作　　者：吕清清 徐兵 陈静静[1] LYU Qingqing;XU Bing;CHEN Jingjing(Department of Radiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院放射科,山东青岛266003 [2]山东国欣颐养集团枣庄中心医院CT室

出　　处：《精准医学杂志》2023年第1期59-63,共5页Journal of Precision Medicine

基　　金：青岛市民生科技计划项目(17-3-3-22-nsh)。

摘　　要：目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI增强前后的T_(1)值评价肝细胞癌(hepatocelluar carcinoma,HCC)病理分级的价值。方法回顾性分析2019年3月—2020年6月青岛大学附属医院收治的75例HCC患者(共75枚病灶)的平扫及Gd-EOB-DTPA增强MRI图像,根据Edmondson-Steiner分级将病灶分为低级别组(Ⅰ~Ⅱ级)和高级别组(Ⅲ~Ⅳ级)。采用T_(1)mapping技术,分别测量两组病灶增强前T_(1)值(T_(1)pre)及肝胆特异期T_(1)值(T_(1)-HBP),并计算T_(1)减少值(△T_(1))和T_(1)值减少率(△T_(1)%),比较不同病理分级间T_(1)pre、T_(1)-HBP、△T_(1)、△T_(1)%的差异,并分析各定量指标与病理分级的相关性,对有显著性的指标采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析其检验效能。结果低级别组与高级别组HCC患者T_(1)pre、T_(1)-HBP、△T_(1)%比较差异有显著性(t=-3.725~2.551,P<0.05),△T_(1)比较差异无显著性(P>0.05);相关性分析显示T_(1)pre、T_(1)-HBP与HCC病理分级呈正相关(r=0.293、0.472,P<0.05),△T_(1)%与HCC病理分级呈负相关(r=-0.254,P<0.05),△T_(1)与HCC病理分级无显著相关性(P>0.05);T_(1)pre、T_(1)-HBP、△T_(1)%区分低级别组与高级别组HCC的AUC分别为0.676(95%CI=0.542~0.810,P<0.05)、0.784(95%CI=0.671~0.897,P<0.05)、0.654(95%CI=0.531~0.775,P<0.05),最佳截断值分别为1253.5 ms、875.5 ms与40.5%,相应的灵敏度分别为72.9%、83.3%、39.6%,特异度分别为63.0%、74.1%、92.6%。结论Gd-EOB-DTPA增强MRI T_(1)pre、T_(1)-HBP及△T_(1)%对术前HCC病理分级具有一定的预测价值。Objective To investigate the value of T_(1)value before and after Gd-EOB-DTPA-enhanced MRI in evaluating the pathological grade of hepatocellular carcinoma(HCC).Methods A retrospective analysis was performed for the plain scan and Gd-EOB-DTPA-enhanced MRI images of 75 HCC patients(75 lesions in total)who were admitted to The Affiliated Hospital of Qingdao University from March 2019 to June 2020.According to Edmondson-Steiner grading,lesions were divided into low-grade group(gradeⅠ-Ⅱ)and high-grade group(gradeⅢ-Ⅳ).The T_(1)mapping technique was used to measure pre-enhanced T_(1)value(T_(1)pre)and hepatobiliary-specific T_(1)value(T_(1)-HBP),and the reduction in T_(1)value(△T_(1))and the reduction rate of T_(1)value(△T_(1)%)were calculated.T_(1)pre,T_(1)-HBP,△T_(1),and△T_(1)%were compared between the lesions with different pathological grades,and the correlation between each quantitative index and pathological grade was analyzed.The receiver operating characteristic(ROC)curve and the area under the ROC curve(AUC)were used to analyze the efficiency of each statistically significant index.Results There were significant differences in T_(1)pre,T_(1)-HBP,and△T_(1)%between the low-grade group and the high-grade group(t=-3.725-2.551,P<0.05),while there was no significant difference in△T_(1)between the two groups(P>0.05).Correlation analysis showed that T_(1)pre and T_(1)-HBP were positively correlated with the pathological grade of HCC(r=0.293,0.472,P<0.05),and△T_(1)%was negatively correlated with the pathological grade of HCC(r=-0.254,P<0.05);there was no significant correlation between△T_(1)and the pathological grade of HCC.T_(1)pre,T_(1)-HBP,and△T_(1)%had an AUC of 0.676(95%CI=0.542-0.810,P<0.05),0.784(95%CI=0.671-0.897,P<0.05),and 0.654(95%CI=0.531-0.775,P<0.05),respectively,in differentiating between low-grade HCC and high-grade HCC,with a sensitivity of 72.9%,83.3%,and 39.6%,respectively,and a specificity of 63.0%,74.1%,and 92.6%,respectively,at the optimal cut-off values of 1253.5 ms,875.

关 键 词：癌 肝细胞 磁共振成像 钆DTPA T_(1)mapping 肿瘤分级 诊断 

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]