体素内不相干运动定量参数联合病理评估肝细胞癌的生存预后  

Intravoxel Incoherent Motion Quantitative Parameters Combined with Pathological Grading for Assessing the Survival Prognosis of Hepatocellular Carcinoma

作　　者：史学莲[1] 翟英敏[2] 刘辉[2] 潘江洋[2] 张宁[2] 时高峰[2] SHI Xuelian;ZHAI Yingmin;LIU Hui;PAN Jiangyang;ZHANG Ning;SHI Gaofeng(Department of CT and MRI,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院疼痛科,河北石家庄050011 [2]河北医科大学第四医院CT磁共振科,河北石家庄050011

出　　处：《中国医学影像学杂志》2025年第3期260-266,共7页Chinese Journal of Medical Imaging

基　　金：河北省医学科学研究课题计划(20190083)。

摘　　要：目的探讨体素内不相干运动定量参数与病理分级对肝细胞癌(HCC)术后生存预后的预测价值。资料与方法回顾性分析河北医科大学第四医院2018年10月—2019年11月有完整影像学资料并行根治性手术、术后病理证实的65例HCC,进行5年生存期随访。利用受试者工作特征曲线确定体素内不相干运动定量参数标准表观扩散系数(s ADC)、真性扩散系数(D)、假性扩散系数(D*)、灌注分数(F)等的最佳临界值。采用单因素、多因素Cox回归分析筛选影响HCC术后患者总生存时间的独立预测因素。结果单因素Cox回归分析显示,病理分级(HR=1.588,95%CI 0.936~2.692,P=0.086)、微血管侵犯(HR=2.512,95%CI 1.308~4.823,P=0.006)、中性粒细胞与淋巴细胞比值(HR=1.752,95%CI 1.000~3.068,P=0.050)、s ADC(HR=0.433,95%CI 0.235~0.796,P=0.007)、D(HR=0.262,95%CI 0.121~0.565,P<0.001)、F(HR=2.268,95%CI 1.259~4.087,P=0.006)均为HCC预后的影响因素;多因素Cox回归分析显示,病理分级(Ⅲ、Ⅳ级)是HCC术后患者生存预后的独立危险因素(HR=1.748,95%CI 1.003~3.045,P=0.049);D值>0.916×10-3 mm2/s是其生存预后的独立保护因素(HR=0.249,95%CI 0.113~0.550,P<0.001)。结论肿瘤病理分级(Ⅲ、Ⅳ级)与体素内不相干运动定量参数D值是HCC术后患者生存预后的独立预测因素,两者联合可为临床预后评估提供参考。Purpose To explore the predictive value of intravoxel incoherent motion quantitative parameters and pathological grading for the survival prognosis of patients with hepatocellular carcinoma(HCC)after surgery.Materials and Methods A retrospective analysis was performed on 65 patients with HCC who had complete imaging data and underwent radical surgery at the Fourth Hospital of Hebei Medical University from October 2018 to November 2019.All patients were followed up for a 5-year survival period.The receiver operating characteristic curve was used to determine the optimal cut-off values for intravoxel incoherent motion quantitative parameters,including standard apparent diffusion coefficient(sADC),diffusion coefficient(D),pseudo-diffusion coefficient(D*)and perfusion fraction(F).Univariate and multivariate Cox regression analyses were performed to select independent predictive factors affecting the overall survival time of HCC patients after surgery.Results Univariate Cox regression analysis showed that pathological grading(HR=1.588,95%CI 0.936-2.692,P=0.086),microscopic vascular invasion(HR=2.512,95%CI 1.308-4.823,P=0.006),neutrophil-to-lymphocyte ratio(HR=1.752,95%CI 1.000-3.068,P=0.050),sADC(HR=0.433,95%CI 0.235-0.796,P=0.007),D(HR=0.262,95%CI 0.121-0.565,P<0.001)and F(HR=2.268,95%CI 1.259-4.087,P=0.006)were all prognostic factors.Multivariate Cox regression analysis showed that pathological grade(gradeⅢandⅣ)was the independent risk factor for the survival prognosis of patients after HCC surgery(HR=1.748,95%CI 1.003-3.045,P=0.049);the D value>0.916×10-3 mm2/s was the independent protective factor for their survival prognosis(HR=0.249,95%CI 0.113-0.550,P<0.001).Conclusion The pathological grade(Ⅲ/Ⅳ)as an independent risk factor and higher D values as a protective factor are the independent predictors of survival and prognosis of patients with HCC after surgery,and the combination of the two can provide a reference for clinical prognosis assessment.

关 键 词：癌 肝细胞 磁共振成像 扩散加权成像 体素内不相干运动 危险因素 预后 

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]