动态增强MRI术前预测肝细胞癌微血管浸润  

Dynamic contrast enhanced MRI for preoperative predicting microvascular invasion in hepatocellular carcinoma

作　　者：程蛰承[1] 胡敏[2] 凌生泉 王笛 韦炜 CHENG Zhecheng;HU Min;LING Shengquan;WANG Di;WEI Wei(Department of CT/MRI Room,Huangshan City People’s Hospital,Huangshan 245000,China;Department of ECG Function,Huangshan City People’s Hospital,Huangshan 245000,China;Department of Pathology,Huangshan City People’s Hospital,Huangshan 245000,China;Department of Radiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]黄山市人民医院CT/MRI室,安徽黄山245000 [2]黄山市人民医院心电功能科,安徽黄山245000 [3]黄山市人民医院病理科,安徽黄山245000 [4]中国科学技术大学附属第一医院影像科,安徽合肥230001

出　　处：《中国介入影像与治疗学》2024年第12期767-771,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：2023年黄山市公共卫生创新发展研究计划项目(2023HYF-02)。

摘　　要：目的 观察动态增强MRI(DCE-MRI)术前预测肝细胞癌(HCC)微血管浸润(MVI)的价值。方法 回顾性收集66例经手术病理证实的HCC共68枚病灶(64例单枚、2例2枚病灶),根据病理结果将病灶分为MVI阳性组(n=17)与MVI阴性组(n=51);比较组间术前DCE-MRI定性及定量参数,以多因素二元logistic回归分析筛选HCC MVI术前DCE-MRI特征相关独立危险因素并建立联合模型。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价单一独立危险因素及联合模型的预测效能。结果 MVI阳性组DCE-MRI所示病灶形态不规则、假包膜不完整、瘤内坏死、瘤周子灶、动脉期肝实质一过性强化及马赛克征占比均高于MVI阴性组,病灶最大径大于MVI阴性组,而静门脉期廓清率(PEW)、绝对廓清率(AEW)及相对廓清率(REW)均低于MVI阴性组(P均<0.05)。瘤周子灶(OR=33.777,P=0.003)、病灶最大径≥4.25 cm(OR=6.429,P=0.038)及REW≤0.15(OR=6.148,P=0.028)均为HCC MVI的独立危险因素,其与联合模型的AUC分别为0.755、0.719、0.781及0.897。结论 DCE-MRI可有效术前预测HCC MVI。Objective To explore the value of dynamic contrast enhanced MRI(DCE-MRI)for preoperative predicting microvascular invasion(MVI)in hepatocellular carcinoma(HCC).Methods Sixty-eight HCC lesions in 66 patients(64 with single and 2 with 2 lesions)confirmed by surgery and pathology were retrospectively enrolled and were divided into MVI-positive group(n=17)and MVI-negative group(n=51)according to pathological results.Preoperative DCE-MRI qualitative and quantitative parameters of lesions were compared between groups,and the independent risk factors related to preoperative DCE-MRI features of HCC MVI were screened by multivariate binary logistic regression analysis,then a combined model was established.Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of single independent risk factor and combined model.Results DCE-MRI showed that the proportion of irregular shape,incomplete pseudocapsule,intratumoral necrosis,peritumoral satellite nodules,transient hepatic parenchymal enhancement in arterial phase and mosaic appearance in MVI-positive group were all higher than those in MVI-negative group,the maximum diameter of lesions in MVI-positive group was larger than that in MVI-negative group,while portal-phase enhancement washout(PEW),absolute enhancement washout(AEW)and relative enhancement washout(REW)in MVI-positive group were all lower than those in MVI-negative group(all P<0.05).Peritumoral satellite nodules(OR=33.777,P=0.003),the maximum diameter of lesion≥4.25 cm(OR=6.429,P=0.038)and REW≤0.15(OR=6.148,P=0.028)were all independent risk factors of MVI in HCC.The AUC of the above single independent risk factors and combined model was 0.755,0.719,0.781 and 0.897,respectively.Conclusion DCE-MRI could effectively preoperatively predict MVI in HCC.

关 键 词：癌 肝细胞 磁共振成像 微血管浸润 

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