钆塞酸二钠增强MRI的LI-RADS征象术前预测GPC3阳性肝细胞癌及术后复发的研究  被引量:2

Preoperative prediction of GPC3 positive hepatocellular carcinoma and postoperative recurrence with the LI-RADS features on gadoxetate disodium-enhanced MRI

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作  者:张宁[1] 武明辉[2] 于长江 周怡然 王聪 师丹丹 朱绍成[2] Zhang Ning;Wu Minghui;Yu Changjiang;Zhou Yiran;Wang Cong;Shi Dandan;Zhu Shaocheng(Department of Medical Imaging,Henan Provincial People′s Hospital of Xinxiang Medical College,Xinxiang 453003,China;Department of Medical Imaging,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区:[1]新乡医学院河南省人民医院影像科,新乡453003 [2]河南省人民医院影像科,郑州450003

出  处:《中华放射学杂志》2024年第1期64-70,共7页Chinese Journal of Radiology

基  金:河南省重点研发与推广专项(212102310729);郑州市协同创新重大专项(20XTZX11020)。

摘  要:目的探讨基于肝胆特异性对比剂钆塞酸二钠增强肝脏影像报告和数据系统2018版(LI-RADS v2018)影像征象预测磷脂酰肌醇蛋白聚糖3(GPC3)阳性肝细胞癌(HCC)的效能,评估GPC3阳性HCC患者术后复发的相关临床影像学特征。方法本研究为队列研究,回顾性收集2017年1月至2021年12月在河南省人民医院行钆塞酸二钠增强MRI并接受肝肿瘤切除术的122例HCC患者,GPC3阳性患者96例,GPC3阴性患者26例。分析HCC病灶的LI-RADS v2018定义的影像学征象。对患者进行为期40个月的随访,确定无复发生存期(RFS)。采用logistic回归分析确定GPC3阳性的危险因素,构建影像模型,并联合患者甲胎蛋白水平,构建临床-影像模型。使用受试者操作特征曲线评估模型预测GPC3阳性的效能。以Kaplan-Meier法绘制生存曲线,log-rank检验用于比较GPC3阳性与阴性患者的RFS。以Cox回归评估影响GPC3阳性HCC复发的危险因素。结果logistic多因素回归结果显示晕环状强化(OR=5.685,95%CI 1.229~26.287,P=0.026)、肝胆期肿瘤边缘不规则突起(OR=4.431,95%CI 1.684~11.663,P=0.003)为GPC3阳性的独立危险因素,影像模型预测GPC3阳性的曲线下面积(AUC)为0.745(95%CI 0.636~0.854),临床-影像模型的AUC为0.776(95%CI 0.677~0.876)。GPC3阳性组平均RFS为22个月,阴性组平均RFS为32个月,差异有统计学意义(χ^(2)=5.15,P=0.023)。多因素Cox回归分析结果表明动脉期周边高强化(HR=5.460,95%CI 1.966~15.162,P=0.001)、微血管浸润(HR=2.402,95%CI 1.210~4.769,P=0.012)、门静脉癌栓(HR=3.226,95%CI 1.114~9.344,P=0.031)是GPC3阳性HCC肝肿瘤切除术后复发的独立危险因素。结论基于肝胆特异性对比剂钆塞酸二钠增强LI-RADS v2018影像学征象构建的模型可有效预测GPC3阳性HCC,动脉期周边高强化、微血管浸润、门静脉癌栓是GPC3阳性HCC术后复发的独立危险因素。Objective To investigate the predictive ability of Glypican-3(GPC3)positive hepatocellular carcinoma based on the hepatobiliary specific contrast agent gadoxetate disodium enhancement of the liver imaging reporting and data system version 2018(LI-RADS v2018)imaging features,and to assess the relevant clinical imaging features for postoperative recurrence in GPC3 positive HCC patients.Methods This study was a cohort study.A total of 122 hepatocellular carcinoma patients who underwent gadoxetate disodium enhanced MRI examination with hepatic tumor resection in Henan Provincial People′s Hospital from January 2017 to December 2021 were retrospectively collected,including 96 GPC3 positive and 26 GPC3 negative patients.The imaging features defined by LI-RADS v2018 of HCC lesions were analyzed.Patients were followed up for 40 months to determine recurrence free survival(RFS).The logistic regression was used to analyze the risk factors of GPC3 positivity.An imaging model,and a clinical-imaging model which combined the patient′s alpha-fetoprotein levels were constructed.The efficacy of the model for predicting GPC3 positivity was assessed using receiver operating characteristic curves.Kaplan-Meier method was used to draw the survival curve,and the log-rank test was used to compare the RFS between GPC3 positive and negative patients.Risk factors affecting the recurrence of GPC3 positive HCC were assessed by Cox regression.Results The results of logistic multivariate regression analysis confirmed that rim enhancement(OR=5.685,95%CI 1.229-26.287,P=0.026)and irregular tumor margin at hepatobiliary phase(OR=4.431,95%CI 1.684-11.663,P=0.003)were independent risk factors for GPC3 positive HCC.The area under the curve for predicting GPC3 positivity was 0.745(95%CI 0.636-0.854)for the imaging model and 0.776(95%CI 0.677-0.876)for the clinical-imaging model.The mean RFS in the GPC3 positive group was 22 months,and it was 32 months in the negative group.There was a statistically significant difference in RFS between the two grou

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

分 类 号:R735.7[医药卫生—肿瘤]

 

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