临床特征结合MRI在AFP阴性HCC与FNH鉴别诊断中的应用及模型建立  

Application of Clinical Features Combined with MRI in the Differential Diagnosis of Alpha-fetoprotein Negative Hepatocellular Carcinoma and Focal Nodular Hyperplasia and Model Establishment

作　　者：王鑫 葛英健 王金凤 庞志斌 王永存 WANG Xin;GE Ying-jian;WANG Jin-feng;PANG Zhi-bin;WANG Yong-cun(Department of Imaging,Rimag Imaging Medical Diagnostic Center,Qiqihar 161005,Heilongjiang Province,China;Department of imaging,Hospital of Traditional Chinese Medicine of Qiqihar,Qiqihar 161005,Heilongjiang Province,China)

机构地区：[1]齐齐哈尔一脉阳光医学影像诊断中心影像科,黑龙江齐齐哈尔161005 [2]齐齐哈尔市中医医院影像科,黑龙江齐齐哈尔161005

出　　处：《中国CT和MRI杂志》2024年第6期111-114,共4页Chinese Journal of CT and MRI

基　　金：3.0T磁共振在创伤性警从神经损伤中的应用研究(CSFGG-2020035)。

摘　　要：目的 探讨甲胎蛋白(AFP)阴性肝细胞肝癌(HCC)与肝局灶性结节增生(FNH)的临床特征与磁共振成像(MRI)影像学差异,并建立Logistic回归诊断模型进行模型验证。方法 回顾性分析2020年8月~2022年8月我院72例AFP阴性HCC患者(HCC组)及72例FNH患者(FNH组)临床与MRI资料。分析两组临床与MRI特征差异,通过多因素非条件Logistic回归分析筛选危险因素,建立回归方程建立预测模型。另收集2022年9月~2023年5月来院就诊的70例患者作为验证组(HCC为32例,FNH为48例),以受试者工作特征(ROC)进行验证。结果 HCC组年龄、乙肝病史比例高于FN H组(P<0.05);HCC组有包膜、病灶含脂肪、病灶坏死或囊变、快进快出强化及病灶出血比例高于FNH组,中央瘢痕及延迟显像比例低于FNH组比例低于FNH组(P<0.05);Logistic回归分析显示,年龄大、乙肝病史、有包膜、无中央瘢痕、病灶含脂肪、病灶坏死或囊变、强化模式为快进快出及非延迟显像均为HCC独立危险因素(P<0.05);经过Logistic回归分析,建立诊断模型:logit(p)=年龄×1.287+乙肝病史×1.469+有包膜×1.535+中央瘢痕×(-0.954)+病灶含脂肪×1.194+病灶坏死或囊变×1.233+强化模式×(-1.169)+延迟显象×(-0.852);模型内部验证:诊断AUC为0.975,95%CI为0.809~0.912,外部验证:模型的AUC为0.871,95%CI为0.944~0.992,χ^(2)为15.398患者。结论 AFP阴性HCC在年龄、乙肝病史及MRI影像学有无包膜、中央瘢痕、病灶含脂肪/强化模式及延迟显像方面存在差异,经Logistic回归分析显示,上述临床特征及MRI影像学表现均为AFP阴性HCC的独立危险因素,且据此构建的诊断模型对AFP阴性HCC具有较好的诊断效能。Objective To investigate the differences of clinical features and magnetic resonance imaging(MRI)between alpha-fetoprotein(AFP) negative hepatocellular carcinoma(HCC) and focal nodular hyperplasia(FNH),,establish a Logistic regression diagnostic model and verify the model.Methods Clinical and MRI data of 72 AFP negative HCC patients(HCC group) and 72 FNH patients(FNH group)in our hospital from August 2020 to August 2022 were retrospectively analyzed.The difference of clinical and MRI features between the two groups was analyzed,and the risk factors were screened by multivariate Logistic regression analysis,and the regression equation was established to establish the prediction model.In addition,70 patients who came to our hospital from September 2022 to May 2023 were selected as the validation group(32 patients with HCC and 48 patients with FNH),and verified by receiver operating cha racteristics(ROC).Results The age and hepatitis B history ratio in HCC group were higher than those in FNH group(P<0.05).The proportion of ca psule,lesion containing fat,lesion necrosis or cystic change,fast in and fast out enhancement and lesion bleeding were higher in HCC group was higher than that in FNH group,and the proportion of central scar and delayed imaging was lower than that in FNH group(P<0.05).Logistic regression analysis showed that age,history of hepatitis B,capsule,no central scar,lesions containing fat,lesion necrosis or cystic change,fast in and fast out mode of enhancement and non-delayed imaging were all independent risk factors for HCC(P<0.05).After Logistic regression analysis,the diagnostic model was established:logit(p)=age×1.287+history of hepatitis B×1.469+enveloped ×1.535+central scar ×(-0.954)+focal fat content×1.194+focal necrosis or cystic change ×1.233+enhancement pattern ×(-1.169)+delayed imaging×(-0.852);Internal validation:diagnostic AUC was 0.975,95%CI was 0.944-0.992,external validation:model AUC was 0.871,95%CI was 0.818-0.914,χ^(2) was 15.398 patients.Conclusion AFP negative HCC has dif

关 键 词：甲胎蛋白 阴性 肝细胞肝癌 肝局灶性结节增生 临床特征 磁共振成像 

分 类 号：R575[医药卫生—消化系统] R445.2[医药卫生—内科学]