肝脏功能影像评分预测肝细胞癌大范围切除术后肝衰竭的应用价值  

Prediction of liver failure in patients with hepatocellular carcinoma after extensive resection by functional liver imaging score

作　　者：黄向阳[1] 覃云英 黄雷 刘丽娟[1] 罗宁斌[1] HUANG Xiangyang;QIN Yunying;HUANG Lei;LIU Lijuan;LUO Ningbin(Department of Radiology,Cancer Hospital Affiliated to Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院放射科,广西南宁530021

出　　处：《实用放射学杂志》2024年第2期226-230,共5页Journal of Practical Radiology

基　　金：广西医科大学青年科学基金项目(GXMUYSF202119)。

摘　　要：目的评估基于术前钆塞酸二钠(Gd-EOB-DTPA)增强MRI的肝脏功能影像学评分(FLIS)对肝细胞癌(HCC)患者行肝切除术后肝衰竭(PHLF)的预测价值。方法回顾性分析行肝大范围切除术并进行术前Gd-EOB-DTPA增强MRI的HCC患者的资料。基于肝胆期图像肝实质强化、胆道排泄及门静脉信号强化3个特征对患者进行FLIS,并评估不同观察者之间的一致性。利用logistic回归模型及受试者工作特征(ROC)曲线分析FLIS预测PHLF的能力。结果120例HCC患者中29例发生PHLF(24.2%)。2名观察者评估FLIS的组内相关系数(ICC)为0.944。多因素logistic回归分析显示FLIS是HCC患者PHLF的独立预测因素[比值比(OR)0.520,95%置信区间(CI)0.355~0.726;P<0.001]。FLIS预测PHLF的曲线下面积(AUC)为0.709,最佳诊断阈值为4,相应的敏感度为78.0%,特异性为58.6%。结论术前FLIS可以预测HCC患者PHLF,有助于为HCC患者制订更为准确的治疗方案。Objective To evaluate the predictive value of functional liver imaging score(FLIS)based on preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI for post-hepatectomy liver failure(PHLF)in patients with hepatocellular carcinoma(HCC).Methods The data of HCC patients who underwent extensive hepatectomy and preoperative Gd-EOB-DTPA enhanced MRI were analyzed retrospectively.The FLIS was scored based on the three features including liver parenchyma enhancement,biliary excretion and portal vein signal enhancement in hepatobiliary phase images,and the consistency between different observers was evaluated.Logistic regression model and receiver operating characteristic(ROC)curve were used to analyze the ability of FLIS to predict the PHLF.Results PHLF occurred in 29 of 120 HCC patients(24.2%).The intraclass correlation coefficient(ICC)of FLIS evaluated by two observers was 0.944.Multivariate logistic regression analysis showed that FLIS was an independent predictor of PHLF of HCC patients[odds ratio(OR)0.520,95%confidence interval(CI)0.355-0.726;P<0.001].The area under the curve(AUC)of FLIS for predicting the PHLF was 0.709,the optimal diagnostic threshold was 4,and the corresponding sensitivity and specificity were 78.0%and 58.6%.Conclusion Preoperative FLIS can predict the PHLF of HCC patients,which may help to make more accurate treatment plans for HCC patients.

关 键 词：肝细胞癌 钆塞酸二钠 磁共振成像 影像学评分 肝切除术后肝衰竭 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R575.3