高分化和非高分化肝癌在钆塞酸二钠多模态MRI中的对照研究

Comparative study of evaluating between the well-differentiated hepatocellular carcinoma and non well-differentiated HCC in Gd-EOB-DTPA multi-modality MRI

目的比较高分化肝癌(WHCC)和非高分化肝癌在钆塞酸二钠(GD-EOB-DTPA)多模态MRI成像中的差异,总结WHCC的MRI影像特点。方法回顾性收集57例经手术病理证实为肝细胞癌(HCC)患者的临床和影像资料,所有患者行肝脏平扫(T1WI和T2WI)、弥散加权成像(DWI)、表观弥散系数(ADC)图、GD-EOB-DTPA增强多期扫描。研究分为WHCC(高分化HCC)及非WHCC(包括中分化和低分化HCC)。统计和分析WHCC与非WHCC在T1WI信号、T2WI信号、DWI信号、ADC图信号、强化模式、肝胆管期信号上的差异。结果将WHCC与非WHCC的影像特征进行对比发现:T1WI信号、肝胆管期信号、ADC图信号、强化模式差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,T1WI信号是预测WHCC的独立影响因素(OR=0.071,P=0.001),进一步比较T1WI的高、等、低3组信号,发现T1WI的高信号对预测WHCC的发生率高于T1WI的等信号和低信号,差异具有统计学意义(P=0.002)。结论 GD-EOB-DTPA多模态成像有利于预测WHCC,其中T1WI信号是独立影响因素,且T1WI的高信号是主要征象,能更好地预测WHCC。

Objective To investigate the differences in GD-EOB-DTPA multi-modality MR images be-tween well-differentiated hepatocellular carcinoma（WHCC）and non well-differentiated HCC.Methods The clin-ical and MR images of 57 patients with pathologically proved HCC were retrospectively collected. All patients un-derwent abdominal enhancement MRI,including T1 weighted and T2 weighted imaging（T1WI and T2WI）,diffu-sion weighted imaging（DWI）,the apparent diffusion coefficient（ADC）map,and gadoxetic acid-enhanced multi-phase sequences. The patients were classified into well-differentiated HCC（WHCC）group and non-WHCC group which combined moderate HCC and poor differentiated HCC according to their histopathological differentiation.Dif-ferences of T1WI,T2WI,DWI,ADC map,the types of HCC on hepatobiliary phase（HBP）images,and enhance-ment patterns on dynamic images were compared. The chi-square test or Fisher exact was used for comparing the imaging signal differences between WHCC and non-WHCC. Multiple logistic regression analysis was performed to identify the independent predictors of WHCC. Results T1WI signal intensities,HBP signal types,enhancement patterns and ADC maps showed statistical significance between WHCC and non-WHCC（P〈0.05）.But,multiple logistic regression analysis showed that signal intensities on T1WI were independent risk factors for WHCC（P =0.001）. In addition,hyperintense on T1WI showed higher statistical significance compared with isointense or hy-pointense on T1WI（P = 0.002）. Conclusions Multi-modality of GD-EOB-DTPA MRI is useful for assessing WHCC. The signal intensities on T1WI are independent risk factors for evaluating WHCC. Moreover,WHCC are more likely in hyperintense T1WI signal intensity.