钆塞酸二钠增强MRI T1 mapping技术在肝细胞癌病理分级中的定量评估价值  

Quantitative evaluation of gadoxetic acid disodium-enhanced MRI T1 mapping in pathological grading of hepatocellular carcinoma

作　　者：韦孟 李光耀 吴树剑 刘希胜[3] Wei Meng;Li Guangyao;Wu Shujian;Liu Xisheng(The First Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241000,China;The Second People's Hospital of Wuhu,Wuhu,Anhui 241000,China;The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]皖南医学院第一附属医院,安徽芜湖241000 [2]芜湖市第二人民医院,安徽芜湖241000 [3]南京医科大学第一附属医院,江苏南京210029

出　　处：《齐齐哈尔医学院学报》2025年第7期650-656,共7页Journal of Qiqihar Medical University

基　　金：安徽省临床医学研究转化专项项目(202427b10020138)。

摘　　要：目的 探讨基于肝脏特异性对比剂钆塞酸二钠(Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, Gd-EOB-DTPA)增强MRI T1mapping技术的定量参数在评估肝细胞癌(Hepatocellular carcinoma, HCC)病理分级中的价值。方法 选择2018年1月—2022年12月本院收治的34例HCC患者作为研究对象,根据Edmondson-Steiner病理分级标准,按病灶分为低级别组(Ⅰ~Ⅱ级)和高级别组(Ⅲ~Ⅳ级)两组,低级别组19例,高级别组15例。所有患者均接受平扫期和肝胆特异期的T1mapping成像。测量肿瘤实质、肿瘤整体、瘤周1cm区域及正常肝实质的T1弛豫时间。结合红细胞压积水平,计算肿瘤实质和肿瘤整体的细胞外容积分数(Extracellular volume, ECV)。比较各定量参数间的组间差异,并评估具有统计学意义的定量参数与病理分级的相关性。对于显著相关的指标,使用受试者工作特征(Receiver operating characteristic, ROC)曲线和曲线下面积(Area under the curve, AUC)评估其效能。结果 高级别组患者的肿瘤长径、瘤周1 cm增强前T1弛豫时间(T1pre)、肿瘤实质T1pre值、肿瘤实质增强后肝胆特异期T1弛豫时间(T1post)及肿瘤整体T1pre值均高于低级别组,差异具有统计学意义(P<0.05);相关性分析显示,病灶长径、瘤周1 cm T1pre值、肿瘤实质T1pre值、肿瘤实质T1post值及肿瘤整体T1pre值与HCC病理分级呈正相关(r=0.47、0.39、0.38、0.40、0.37,P均<0.05),其诊断效能AUC分别为0.758、0.726、0.709、0.719、0.691,联合模型的AUC为0.870。结论 基于Gd-EOB-DTPA增强MRI T1mapping技术的定量评估在HCC病理分级中具有重要价值。Objective To explore the value of quantitative parameters based on liver-specific contrast agent Gd-EOB-DTPA-enhanced MRI T1 mapping in assessing pathological grading of hepatocellular carcinoma(HCC).Methods A retrospective analysis was conducted on the clinical,pathological,and enhanced MRI data of 34 patients with pathologically confirmed HCC at the First Affiliated Hospital of Nanjing Medical University.According to the Edmondson-Steiner grading system,the lesions were classified into a low-grade group(gradeⅠ~Ⅱ)(n=19)and a high-grade group(gradeⅢ~Ⅳ)(n=15).All patients underwent T1 mapping during both the pre-contrast and equilibrium phases.The T1 relaxation times of the tumor parenchyma,whole tumor,a 1cm peritumoral area,and normal liver parenchyma were measured.The extracellular volume(ECV)of the tumor parenchyma and the whole tumor was calculated by combining these measurements with the hematocrit levels.The differences in quantitative parameters between the groups were compared,and the correlations between statistically significant quantitative parameters and pathological grades were evaluated.For significant indicators,the diagnostic performance was assessed using receiver operating characteristic(ROC)curves and the area under the curve(AUC).Results Significant differences were found between the low-grade and high-grade HCC groups in lesion length,T1 relaxation time before enhancement(T1pre)in the 1 cm peritumoral area,T1pre in the tumor parenchyma,T1 relaxation time in the tumor parenchyma during the post-contrast equilibrium phase(T1post),and T1pre in the whole tumor(P<0.05).Correlation analysis showed that lesion length,T1pre in the 1 cm peritumoral area,T1pre in the tumor parenchyma,T1post in the tumor parenchyma,and T1pre in the whole tumor were positively correlated with HCC pathological grades(r=0.47,0.39,0.38,0.40,0.37,all P<0.05).The diagnostic performance AUCs were 0.758,0.726,0.709,0.719,and 0.691,respectively,with the combined model yielding an AUC of 0.870.Conclusions Quantitative eval

关 键 词：钆塞酸二钠 磁共振成像 T1 mapping 肝细胞癌 肿瘤分级 

分 类 号：R735.7[医药卫生—肿瘤]