Gd-EOB-DTPA增强MRI对CK19阳性小肝癌(≤3 cm)的评估价值  

The value of Gd-EOB-DTPA-enhanced MRI in predicting CK19-positive in patients with small hepatocellular carcinoma(≤3cm)

作　　者：刘茂童 张涛 张学琴 徐磊 张继云 姜吉锋 瞿琦 鲁梦恬 LIU Mao-tong;ZHANG Xue-qin;ZHANG Tao(Department of Radiology,Nantong Third Hospital Affiliated to Nantong University,Jiangsu 226000,China)

机构地区：[1]南通大学附属南通第三医院,南通市第三人民医院影像科,江苏226000

出　　处：《放射学实践》2023年第9期1101-1107,共7页Radiologic Practice

基　　金：2021年度南通市卫生健康委员会科研立项课题(QA2021037)。

摘　　要：目的:通过比较CK19阳性与CK19阴性小肝癌患者的术前MRI图像,确定与CK19阳性表达相关的影像表现。方法:回顾性搜集接受根治性肝切除术的94例CK19阴性和33例CK19阳性肝细胞癌(病灶直径≤3 cm)患者,由2位放射科医生分别评估其术前MRI图像和相关血生化检测结果,通过单因素和多因素分析进行定性及定量比较,确定与小肝癌CK19阳性表达相关的风险因素,并构建预测小肝癌CK19阳性表达的列线图。采用组内相关系数和Kappa值评估2位观察者之间的一致性。结果:单因素分析结果显示,CK19阴性组与CK19阳性组的AFP值、动脉期环形强化、动脉期瘤周强化、DWI靶环征和LLRhp差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,动脉期环形强化、DWI靶环征和LLRhp降低是与小肝癌CK19阳性表达相关的风险因素。2位观察者间定性及定量数据的一致性均较高。AFP升高、动脉期环形强化、动脉期瘤周强化、DWI靶环征和LLRhp降低预测小肝癌CK19阳性表达的曲线下面积(AUC)分别为0.633、0.685、0.628、0.674和0.670,联合3个因素的列线图预测小肝癌CK19阳性表达的AUC为0.838。结论:Gd-EOB-DTPA增强MRI动脉期环形强化、DWI靶环征和LLRhp降低是小肝癌CK19阳性表达的风险因素。Objective:To identify the imaging manifestations associated with positive CK19 expression by comparing preoperative MRI images in patients with CK19-positive and CK19-negative small hepatocellular carcinoma(HCC).Methods:94 patients with CK19-negative small HCC and 33 patients with CK19-positive small HCC who underwent radical resection were retrospectively analyzed.Two radiologists evaluated their preoperative MRI images and relevant blood biochemical test results separately,compared qualitatively and quantitatively by univariate and multifactorial analysis and identified important factors associated with CK19-positive small HCC,and finally constructed nomogram to predict positive CK19 expression in patients with small HCC.Intra-class correlation coefficients and kappa values were used to assess the agreement between the two observers.Results:In the univariate analysis,statistically significant differences were found in elevated AFP,arterial-phase rim enhancement,arterial-phase peri-neoplastic enhancement,DWI target ring sign,and decreased LLRhp.Multivariate logistic regression analysis showed that arterial phase rim enhancement,DWI target ring sign and LLRhp reduction were significant factors associated with CK19-positive small HCC.The agreement between the two observers was high for both qualitative and quantitative data.The area under the curve(AUC)predicted by elevated AFP,arterial phase rim enhancement,arterial phase perineural enhancement,DWI target ring sign and decreased LLRhp were 0.633,0.685,0.628,0.674 and 0.670,respectively.The nomogram combining the three factors yield the AUC of 0.838 for predicting CK19 positive expression in HCC.Conclusion:The signs of arterial phase rim enhancement,DWI target ring sign and LLRhp reduction in Gd-EOB-DTPA-enhanced MRI are important predictors of CK19-positive in small HCC.

关 键 词：肝细胞癌 CK19 磁共振成像 Gd-EOB-DTPA增强MRI 

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