三维酰胺质子转移成像在预测肝细胞癌病理分级中的初步研究  

Preliminary study of three-dimensions amide proton metastasis imaging in the prediction of pathological grade of hepatocellular carcinoma

作　　者：齐晓辉[1] 王琦[1] 沈智威 段梦婷 刘响[1] 潘江洋[1] 王丽佳[1] 贾丽涛[1] 王亚宁[1] 杜煜[1] QI Xiaohui;WANG Qi;SHEN Zhiwei;DUAN Mengting;LIU Xiang;PAN Jiangyang;WANG Lijia;JIA Litao;WANG Yaning;DU Yu(Department of CT/MRI,No.4 Hospital of Hebei Medical University,Shijiazhuang 050000,China;Philips(China)Investment Co.,Ltd.,Beijing 100600,China)

机构地区：[1]河北医科大学第四医院CT/MRI科,石家庄050000 [2]飞利浦(中国)投资有限公司,北京100600

出　　处：《磁共振成像》2025年第4期48-53,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：河北省医学科学研究课题计划项目(编号:20221276)。

摘　　要：目的 探讨三维酰胺质子转移加权(three-dimensions amide proton transfer weighted,3D-APTw)成像在评估肝细胞癌(hepatocellular carcinoma,HCC)病理分级中的价值。材料与方法 前瞻性招募2020年10月至2023年4月经手术病理证实为HCC并进行Edmondson-Steiner四级(Ⅰ~Ⅳ)分级的患者共43例。将Ⅰ级和Ⅱ级HCC定为低级别HCC,Ⅲ级和Ⅳ级病变定为高级别HCC。采用飞利浦3.0 T MRI设备在术前对患者进行扫描,分别采集T1WI、T2WI、弥散加权成像、酰胺质子转移加权(amide proton transfer weighted,APTw)及多期增强图像。由两位经验丰富的放射科医生独立测量HCC及正常肝实质的APTw值。采用Mann-Whitney U非参数检验分析组间差异。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析APTw值的诊断效能,计算曲线下面积(area under the curve,AUC)、阈值及其敏感度和特异度。采用Spearman相关分析,评估APTw与HCC的组织学分级之间的相关性。结果 低级别HCC的APTw值(2.15%±0.13%)低于高级别HCC(2.63%±0.13%),差异具有统计学意义(P=0.03)。APTw值鉴别高级别及低级别HCC的AUC为0.69(95%CI:0.53~0.82),最佳阈值为1.85%时,敏感度和特异度分别为90.00%和42.31%。Spearman相关性分析结果显示APTw值与HCC病理分级呈正相关,相关系数r=0.43(P=0.003)。结论 APTw值可用于鉴别高级别及低级别HCC,3D-APTw成像在术前预测HCC病理分级中有一定的价值。Objective:To explore the value of three-dimensional amide proton transfer weighted(3D-APTw) imaging in the assessment of the pathological grade of hepatocellular carcinoma(HCC).Materials and Methods:A total of 43 patients with surgical pathology confirmed HCC from October 2020 to April 2023 and underwent Edmondson-Steiner grade(grade Ⅰ to Ⅳ) were prospectively recruited.We classified grade Ⅰ and Ⅱ HCC as low grade HCC and grade Ⅲ and Ⅳ lesions as high grade HCC.A Philips 3.0 T MRI device was scanned before surgery to acquire T1WI,T2WI,diffusion-weighted imaging,amide proton transfer weighted(APTw) and multi-stage enhanced images,respectively.APTw values for HCC and hepatplasm were measured independently by two experienced radiologists.Differences between groups were analyzed by the Mann-Whitney U non-parametric test.The diagnostic efficacy of APTw value was analyzed using the receiver operating characteristic(ROC) curve,and the area under the curve(AUC),threshold,sensitivity and specificity were calculated.A Spearman correlation analysis was used to assess the association between APTw and the histological grade of HCC.Results:The APTw value of low grade HCC(2.15% ± 0.13%) was significantly lower than that of high grade HCC(2.63% ±0.13%),and the difference was statistically significant(P = 0.03).The AUC for identifying high grade and low grade HCC was 0.69(95% CI:0.53 to 0.82),and with an optimal threshold of 1.85%,the sensitivity and specificity were 90.00% and 42.31%,respectively.Spearman results of the correlation analysis showed a positive correlation between APTw value and HCC pathological grade,with a correlation coefficient of r = 0.43(P = 0.003).Conclusions:The APTw value can be used to identify high grade and low grade HCC,and the 3D-APTw imaging has some value in predicting the preoperative pathological grade of HCC.

关 键 词：酰胺质子转移成像 肝细胞癌 病理分级 功能磁共振成像 

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]