术前磁共振弥散加权成像联合血清甲胎蛋白对肝细胞癌患者微血管侵犯的预测效能研究  

Study on the predictive efficacy of preoperative MR-DWI combined with serum alpha-fetoprotein for microvascular invasion in patients with hepatocellular carcinoma

作　　者：林晓冬 杨花 何丽 Lin Xiaodong;Yang Hua;He Li(Department of Radiology,Zhangjiagang Hospital of Traditional Chinese Medicine,Zhangjiagang 215600,China;Department of Laboratory,Zhangjiagang Hospital of Traditional Chinese Medicine,Zhangjiagang 215600,China)

机构地区：[1]张家港市中医医院放射科,张家港215600 [2]张家港市中医医院检验科,张家港215600

出　　处：《中国医学装备》2024年第9期53-59,共7页China Medical Equipment

基　　金：江苏省卫生健康委医学科研项目(H2020147)。

摘　　要：目的:探讨术前磁共振弥散加权成像(DWI)的表观弥散系数(ADC)值、指数化ADC(eADC)值联合血清甲胎蛋白(AFP)对肝细胞癌(HCC)患者微血管侵犯(MVI)的预测效能。方法:前瞻性选取2017年1月至2023年2月在张家港市中医医院拟行肝癌切除术治疗的133例HCC患者,根据术后病理诊断有无MVI将其分为MVI阳性组(62例)和MVI阴性组(71例),比较两组术前ADC值、癌组织与正常组织的ADC比值(T/L)和eADC值的比值(eT/L)、血清AFP及其他临床病理资料,采用多因素logistic回归分析HCC患者MVI的危险因素;应用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估各指标单独及联合检测对MVI的预测效能。结果:MVI阳性组ADC值、ADC的T/L均低于MVI阴性组,eADC的eT/L高于MVI阴性组,差异均有统计学意义(t=3.972、5.297、3.521,P<0.05);MVI阳性组和MVI阴性组的eADC值比较差异无统计学意义(P>0.05);MVI阳性组血清AFP为340.25(22.34,1 154.60)/μg/L高于MVI阴性组的56.32(13.85,649.57)/μg/L,差异有统计学意义(U=3.615,P<0.05);MVI阳性组肿瘤直径、谷丙转氨酶(ALT)和总胆红素(TBil)水平大于MVI阴性组,差异均有统计学意义(t=7.686、2.083、2.923,P<0.05);多发病灶、临床分期Ⅲ期、低分化以及无完整包膜患者占比大于MVI阴性组,差异均有统计学意义(x2=6.656、4.600、9.030、5.328,P<0.05)。多因素logistic回归分析显示,肿瘤直径>5 cm、无完整包膜、AFP升高、ADC的T/L降低以及eADC的eT/L升高均是HCC患者发生MVI的危险因素(OR=1.382、1.423、1.043、0.815、1.146,P<0.05)。ROC曲线分析显示,ADC的T/L、eADC的eT/L及AFP预测HCC患者MVI的AUC(95%CI)分别为0.721(0.442~0.988)、0.748(0.525~0.948)和0.720(0.460~0.985),联合预测的AUC(95%CI)为0.860(0.731~0.974),高于其单独预测效能。结论:术前DWI的ADC的T/L降低,eADC的eT/L及血清AFP升高是HCC患者MVI的危险因素,术前ADC的T/L、eADC的eT/L联合血清AFP对HCC患者MVI有较高预测效能。Objective:To investigate the predictive efficacy of apparent diffusion coefficient(ADC),exponential ADC(eADC)of preoperative magnetic resonance diffusion-weighted imaging(MR-DWI)combined with serum alpha fetoprotein(AFP)for microvascular invasion(MVI)in patients with hepatocellular carcinoma(HCC).Methods:A prospective study was conducted on 133 HCC patients who underwent liver cancer resection at Zhangjiagang Hospital of Traditional Chinese Medicine from January 2017 to February 2023.Based on whether occurred MVI in postoperative pathological diagnosis,they were divided into positive MVI group(62 cases)and negative MVI group(71 cases).The preoperative ADC values,ADC ratio(T/L),ratio of eADC value to eADC value(eT/L),serum AFP and other clinical pathological data were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors of MVI in HCC patients.The receiver operating characteristic(ROC)curve and area under curve(AUC)were applied to assess the predictive efficacies of each indicator and the combined detection of all indicator for MVI.Results:The ADC value and T/L value of ADC in the positive MVI group were lower than those in the negative MVI group,while the eT/L value of eADC was higher than that in the negative MVI group,and the differences were statistically significant(t=3.972,5.297,3.521,P<0.05),respectively.There was no statistically significant difference in eADC values between the positive MVI group and the negative MVI group(P>0.05).The serum AFP level in the positive MVI group was higher than that in the negative MVI group,and the difference was statistically significant(U=3.615,P<0.05).The tumor diameter,alanine aminotransferase(ALT)and total bilirubin(TBil)level in the positive MVI group were higher than those in the negative MVI group,and the differences were statistically significant(t=7.686,2.083,2.923,P<0.05),respectively.The proportions of patients with multiple lesions,clinical stage III,low differentiation and incomplete capsule in the positive MVI g

关 键 词：肝细胞癌(HCC) 微血管侵犯(MVI) 表观弥散系数(ADC) 指数化表观弥散系数 甲胎蛋白(AFP) 预测 

分 类 号：R445.2[医药卫生—影像医学与核医学]