钆塞酸二钠增强MRI对肝细胞癌微血管侵犯的预测价值

The value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI in the prediction of microvascular invasion of hepatocellular carcinoma

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI对肝细胞癌(HCC)微血管侵犯(MVI)的预测价值。方法回顾性分析2015年1月至2018年5月南通市第三人民医院经手术病理证实为HCC,在肝脏部分切除或肝移植手术前2周内进行过Gd-EOB-DTPA增强MRI的70例患者。根据术后病理结果是否存在MVI将其分为MVI阳性组及MVI阴性组,并记录甲胎蛋白(AFP)。在Gd-EOB-DTPA增强MRI上进行定性指标观察,包括肿瘤信号是否均匀、瘤周强化、肿瘤包膜、肿瘤边缘是否光整、瘤周低信号和肿瘤内是否存在脂肪;观察记录定量指标,包括肿瘤直径和增强后动脉期、门静脉期、过渡期及肝胆期病灶-竖脊肌信号比的增长率(ΔLMR)。MVI阴性组及MVI阳性组定性参数比较采用χ2检验,非正态定量参数比较采用Mann-WhitneyU检验。在纳入及不纳入肝胆期瘤周低信号两种情况下分别将单因素分析差异有统计学意义的参数作为自变量进行多因素logistic回归分析,得出预测概率1(pre-1)和预测概率2(pre-2),并将两者作为自变量,以有MVI为金标准,采用ROC分析两者对HCCMVI的诊断效能,并采用Z检验比较pre-1和pre-2的ROC下面积。结果MVI阳性组26例共27个病灶,MVI阴性组44例共50个病灶。MVI阴性组与MVI阳性组间瘤周强化、肿瘤包膜、肿瘤边缘、肝胆期瘤周低信号的差异有统计学意义(P<0.05),性别分布、肿瘤信号均匀性及瘤内脂肪的差异无统计学意义(P>0.05)。MVI阴性组与MVI阳性组间病灶直径的差异有统计学意义(P<0.05),两组间患者年龄、AFP值及增强各期ΔLMR差异均无统计学意义(P>0.05)。纳入参数包括肝胆期瘤周低信号时,肿瘤直径、肿瘤边缘不光整和瘤周低信号为HCCMVI的独立危险因素,联合诊断MVI的灵敏度和特异度分别为77.8%和94.0%;纳入参数不包括肝胆期瘤周低信号时,肿瘤直径和肿瘤边缘不光整为HCCMVI的独立危险因素,联合诊断MVI的灵敏度和特异度分别为59.3%和92.0%。pre-1、pre-2诊断HCCMVI的ROC下面积分别为0.900和0.816,差异有统计学意义(P<0.05)。结论利用Gd-EOB-DTPA增强MRI可术前预测HCCMVI,特别是肝胆期瘤周低信号对MVI的预测具有重要价值。

Objective To investigate the predictive value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI for microvascular invision (MVI) in hepatocellular carcinoma (HCC). Methods Retrospective analysis of 70 patients confirmed by pathology as HCC who underwent Gd-EOB-DTPA-enhanced MRI within 2 weeks prior to liver partial resection or liver transplantation surgery from January 2015 to May 2018 in Nantong Third People′s Hospital. According to the pathological results of the postoperative pathology, MVI was divided into MVI positive group and MVI negative group, and alpha fetoprotein (AFP) was recorded. In Gd-EOB-DTPA-enhanced MRI, qualitative indicators including whether the tumor signal was uniform, peritumoral enhancement, tumor capsule, tumor margin, peritumor hypointensity and presence of fat in the tumor were assessed. Quantitative indicators including tumor diameter and the increase rate of liver-to-muscle ratio(ΔLMR) of post-enhancement arterial phase, portal vein phase, transitional phase and hepatobiliary phase were assessed and recorded. The χ2 test was used to compare the qualitative parameters of the MVI-negative group and the MVI-positive group, and the Mann-Whitney U test was used to compare the non-normal quantitative parameters. In both inclusion and non-inclusion of peritumor hypointensity cases in the hepatobiliary phase. The multivariate logistic regression analysis was performed to indicate independent variables after univariate analysis. The prediction probability 1 (pre-1) and the prediction probability 2 (pre-2) were obtained, and the two as independent variables. with MVI as the gold standard, using ROC to analyze the diagnostic efficacy of both for HCC MVI, and using Z test to compare the area under the ROC of pre-1 and pre-2. Results There were 27 lesions in 26 cases of MVI-positive group and 50 lesions in 44 cases of MVI-negative group. There was a statistically significant difference between the MVI-negative group and the MVI-positive group in peritumoral enhancement, tumor capsule, tumor margin and peritumor hypointensity in the hepatobiliary phase (P<0.05), and there was no statistically significant difference in gender distribution, tumor signal uniformity and intratumoral fat (P>0.05). There was significant difference in lesion diameter between MVI-negative group and MVI-positive group (P<0.05) while no significant difference in age, AFP value and ΔLMR between the two groups (P>0.05). Multivariate logistic regression analysis showed that tumor diameter, non-smooth tumor margin and peritumor hypointensity were independent risks of MVI when peritumor hypointensity was included, the sensitivity and specificity of the combined diagnosis of MVI were 77.8% and 94.0%;Multivariate logistic regression analysis showed that tumor diameter and non-smooth tumor margin were independent risks of MVI when peritumor hypointensity was not included, the sensitivity and specificity of the combined diagnosis of MVI were 59.3% and 92.0%. The the area under the ROC of pre-1 and pre-2 were 0.900 and 0.816, their difference was statistically significant (P<0.05). Conclusion Gd-EOB-DTPA enhanced MRI can be used to predict HCC MVI preoperatively, especially peritumor hypointensity in hepatobiliary phase is important for the prediction of MVI.