Gd-EOB-DTPA增强MRI预测CK19阳性肝细胞癌及其预后的临床价值  

Clinical Value of Disodium Gd-EOB-DTPA Enhanced MRI in Predicting CK19 Positive Hepatocellular Carcinoma and its Prognosis

作　　者：王倩 黎金葵 徐俊霞 杨正高 雷军强[2] WANG Qian;LI Jinkui;XU Junxia(The First Clinical School of Lanzhou University,Lanzhou,Gansu Province 730000,P.R.China)

机构地区：[1]兰州大学第一临床医学院,730000 [2]兰州大学第一医院放射科,730000

出　　处：《临床放射学杂志》2024年第3期388-393,共6页Journal of Clinical Radiology

摘　　要：目的 探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI预测肝细胞癌(HCC)细胞角蛋白19(CK19)表达状态的应用价值,并评估CK19阳性与CK19阴性HCC患者根治性切除术后的预后。方法 回顾性分析行肝切除术的单发HCC患者的MRI和临床病理资料。评估MRI定性、定量特征及临床病理特征与CK19阳性表达的相关性。多因素Logistic回归筛选出CK19阳性HCC的独立预测因素。通过受试者工作特征曲线分析评估CK19表达的预测效能。使用Kaplan-Meier方法评估无复发生存率。结果 共纳入137例患者(CK19阴性组105例,CK19阳性组32例)。动脉期环状高强化、肝胆期肿瘤与肝实质信号强度比(SR)、DWI或HBP靶征和甲胎蛋白(AFP)与CK19阳性HCC相关(P<0.05)。多因素分析示动脉期环状高强化和AFP>400 U/ml是CK19阳性HCC的独立预测因素。联合上述两个指标预测CK19阳性HCC的曲线下面积为0.750,敏感度为72.4%,特异度为75.9%。与CK19阴性HCC患者相比,CK19阳性HCC患者在肝切除后的无复发生存率(RFS)较低(1年RFS 65.5%vs 81.4%,2年RFS 51.0%vs 65.9%),但两者差异无显著统计学意义(log-rankP=0.164)。结论 动脉期环状高强化和AFP水平有助于术前预测CK19阳性HCC,在根治性切除术后CK19阳性HCC更易早期复发(2年内)。Objective To investigate the value of Gd-EOB-DTPA enhanced MRI in predicting the expression of cytokeratin 19(CK19) in hepatocellular carcinoma(HCC),and to evaluate the prognosis of patients with CK19 positive HCC and patients with CK19 negative HCC after radical resection.Methods MRI and clinicopathological data of HCC patients undergoing hepatectomy were analyzed retrospectively.To evaluate the correlation between MRI qualitative 、quantitative indicator,clinicopathological characteristics and CK19 positive expression.Multivariate logistic regression was used to identify independent predictors of CK19 positive HCC.The predictive efficacy of CK19 expression was evaluated by analyzing the working characteristic curve of subjects.Kaplan-Meier method was used to evaluate relapse free survival.Results Totally 137 patients were included(105 in CK19 negative group and 32 in CK19 positive group).CK19 positive HCC was correlated with arterial rim enhancement,tumor-to-liver signal intensity ratio(SR) on hepatobiliary phase,DWI or HBP target sign and alpha fetoprotein(AFP)(P<0.05).Multivariate analysis showed arterial rim enhancement and AFP>400 IU/ml were independent predictors of CK19 positive HCC.The area under the curve of CK19 positive HCC predicted by combining the above two indicators was 0.750,the sensitivity was 72.4%,and the specificity was 75.9%.Compared with CK19 negative HCC patients,the recurrence free survival(RFS) of CK19 positive HCC patients after hepatectomy was lower(65.5% vs 81.4% at 1 year,51.0% vs 65.9% at two years),but there was no significant difference between the two groups(log-rank P=0.164).Conclusion arterial rim enhancement and AFP level in arterial phase are helpful to predict CK19 positive HCC before operation,and CK19 positive HCC is more likely to early recurrence(<2 years) after radical resection.

关 键 词：肝细胞癌 磁共振成像 细胞角蛋白19 预后 

分 类 号：R735.7[医药卫生—肿瘤]