基于钆塞酸二钠增强MRI对孤立性肝细胞癌射频消融术后早期复发的危险因素分析  

Risk Factors for Early Recurrence of Solitary Hepatocellular Carcinoma After Radiofrequency Ablation Based on Gd-EOB-DTPA-Enhanced MRI

作　　者：许倩 张岚[2,3] 黄婷婷[2,3] 高宇[2] 翟晓阳 张嘉诚 何旭 时付坤 XU Qian;ZHANG Lan;HUANG Tingting;GAO Yu;ZHAI Xiaoyang;ZHANG Jiacheng;HE Xu;SHI Fukun(Department of MRI,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;Zhengzhou Key Laboratory of Intelligent Analysis and Utilization of Traditional Chinese Medicine Information,Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学影像医学与核医学系,河南郑州450046 [2]河南中医药大学第一附属医院MRI科,河南郑州450000 [3]河南中医药大学中医药信息智能分析与利用郑州市重点实验室,河南郑州450000

出　　处：《中国医学影像学杂志》2025年第3期238-244,259,共8页Chinese Journal of Medical Imaging

基　　金：河南省中医药科学研究专项课题(2024ZY3008);河南省医学科技攻关计划项目(LHGJ20230679);医学科学研究基金科研项目(YWJKJJHKYJJ-BXS5-22039);国家自然科学基金项目(82204933)。

摘　　要：目的探讨基于钆塞酸二钠增强MRI结合临床特征筛选孤立性肝细胞癌射频消融术后早期复发的独立危险因素。资料与方法收集2019年1月—2022年6月于河南中医药大学第一附属医院接受射频消融治疗的孤立性肝细胞癌患者的临床和影像资料,经典型影像学检查或穿刺活检确诊。所有患者术前行钆塞酸二钠增强MRI检查,并随访至术后2年。采用单因素及多因素Cox比例风险回归分析肝细胞癌患者射频消融术后复发的独立危险因素。结果共纳入58例患者,根据随访结果分为早期复发组22例和无早期复发组36例。多因素Cox回归分析结果显示,术前甲胎蛋白水平(HR=1.103,95%CI 1.008~1.206,P=0.033)、动脉期不规则边缘强化(HR=4.647,95%CI 1.527~14.110,P=0.007)、动脉期瘤周强化(HR=11.575,95%CI 3.575~37.478,P=0.001)以及肝胆期瘤周低信号(HR=5.058,95%CI 1.129~22.668,P=0.034)是射频消融术后早期复发的独立危险因素。甲胎蛋白联合动脉期不规则边缘强化、动脉期瘤周强化及肝胆期瘤周低信号任一影像征象的曲线下面积分别为0.896、0.842和0.860,准确度分别为81.0%、84.5%和82.8%。结论术前血清甲胎蛋白水平、动脉期不规则边缘强化、动脉期瘤周强化和肝胆期瘤周低信号是肝细胞癌射频消融治疗后早期复发的独立危险因素,联合甲胎蛋白与上述任一MRI征象能显著提高预测效能。Purpose To investigate the independent risk factors for early recurrence of solitary hepatocellular carcinoma after radiofrequency ablation based on gadoxetic acid disodium(Gd-EOB-DTPA)-enhanced MRI combined with clinical features.Materials and Methods Clinical and imaging data of hepatocellular carcinoma patients who underwent radiofrequency ablation at the First Affiliated Hospital of Henan University of Chinese Medicine from January 2019 to June 2022 were retrospectively collected.All patients underwent preoperative Gd-EOB-DTPA-enhanced MRI and were followed up for up to two years post-surgery.Univariate and multivariate Cox proportional hazards regression were performed to identify independent risk factors for recurrence after radiofrequency ablation.Results A total of 58 patients were finally included,including early recurrence group(n=22)and non-early recurrence group(n=36).Multivariate Cox regression analysis revealed that preoperative alpha-fetoprotein(AFP)levels(HR=1.103,95%CI 1.008-1.206,P=0.033),arterial-phase irregular margin enhancement(HR=4.647,95%CI 1.527-14.110,P=0.007),peritumoral arterial-phase enhancement(HR=11.575,95%CI 3.575-37.478,P=0.001)and peritumoral hepatobiliary phase hypointensity(HR=5.058,95%CI 1.129-22.668,P=0.034)were independent risk factors for early recurrence.The area under the curve for AFP combined with arterial-phase irregular margin enhancement,peritumoral arterial-phase enhancement and peritumoral hepatobiliary phase hypointensity were 0.896,0.842 and 0.860,with accuracy rates of 81.0%,84.5%and 82.8%,respectively.Conclusion Preoperative serum AFP levels,arterial-phase irregular margin enhancement,peritumoral arterial-phase enhancement and peritumoral hepatobiliary phase hypointensity are independent risk factors for early recurrence after radiofrequency ablation in hepatocellular carcinoma patients.The combination of AFP and any of these MRI features significantly improves predictive efficacy.

关 键 词：癌 肝细胞 复发 磁共振成像 射频消融 钆塞酸二钠 危险因素 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]