磁共振CDT-VIBE成像技术在肝细胞癌术前分级中的应用研究

Application Research of CDT-VIBE Magnetic Resonance Imaging Technique in Preoperative Grading of Hepatocellular Carcinoma

目的研究不同分化程度肝细胞肝癌（HCC）经CDT-VIBE成像技术扫描后所得定量参数的差异,探讨CDT-VIBE成像技术在HCC术前分级中的应用价值。方法搜集HCC患者55例,男44例,女11例,平均年龄（54.20±9.13）岁,所有患者均经外科手术或穿刺活检病理证实为HCC。采用国际上常用的Edmondson-Steiner四级（Ⅰ~Ⅳ）分级方法,其中Ⅰ、Ⅱ级纳入高级别组,Ⅲ、Ⅳ级纳入低级别组。扫描采用1.5 T磁共振扫描设备（Siemens Magnetom Area）,包括常规腹部平扫,轴位T1mapping及快速动态增强扫描。其中,快速动态增强扫描采用CDT-VIBE序列,单期扫描用时3 s,共连续扫描39期,于第4期后经肘静脉置管团注马根维显（0.2 ml/kg）。采用Siemens后处理工作站MMWP上的Tissue 4D软件处理图像,获取灌注相关参数,包括K^trans值、Kep值、Ve值和iAUC值。利用SPSS 19.0软件,对不同分化程度的HCC病灶的上述参数进行分析,验证各参数差异有无统计学意义,并用ROC曲线对其进行诊断效能分析。结果高、低级别组及正常肝组织之间的K^trans值、Kep值、Ve值及iAUC值,差异有统计学意义（P〈0.01）,其中高级别组K^trans、Kep、Ve及iAUC明显高于低级别组,差异有统计学意义（P〈0.01）;K^trans值、Kep值、Ve值及iAUC值的ROC曲线下面积分别为0.987、0.885、0.738、0.976,其中K^trans的诊断效能最佳。结论使用磁共振CDT-VIBE成像技术扫描所得定量参数对HCC进行术前分级,可以在一定程度上鉴别HCC的组织病理学分化程度,对临床选择合适的治疗方案及判断预后具有指导价值。

Objective To evaluate the difference of quantitative parameters of CDT-VIBE scanning technique in hepatocellular carcinoma（ HCC） with various grades of differentiation. To investigate the value of CDT-VIBE imaging in preoperative grading of HCC. Methods 55 patients with hepatocellular carcinoma were collected,44 males and 11 females with an average age of 54. 20 ± 9. 13 years. All the HCC patients were confirmed by surgery or biopsy pathology. The first（ Ⅰ） and second（ Ⅱ） levels were included in the advanced group,and the third（ Ⅲ） and fourth（ Ⅳ） levels were included in the lower level group according to the Edmondson-Steiner four（ Ⅰ-Ⅳ） classification method. The magnetic resonance scanning was performed using 1. 5 T equipment（ Siemens Magnetom Area）,including conventional abdominal scan,axial T1 mapping and fast dynamic enhanced scanning. TWIST-VIBE sequence was used in fast dynamic enhanced scanning,with continuous scanning of 39 phases and single phase for 3 seconds. The injection of Magnetism（ 0. 2 ml/kg）through elbow vein bolus was after fourth phase. The Tissue 4D software on Siemens post-processing workstation MMWP was used to process the images. The perfusion parameters were collected,including K^trans,Kep,Ve and AUC values. SPSS 19 software was used to analyse the parameters of HCC lesions with different degrees of differentiation,and to verify the significance of each parameter. The ROC curve was used to analyze the diagnostic efficiency. Results There was significant difference in K^trans,Kep,Ve and iAUC between high grade group,low grade group and normal hepatic tissue（ P〈0. 01）.The levels of K^trans,Kep,Ve,iAUC in advanced group were higher than those in lower group,with significant difference（ P〈0. 01）. The area under the curve of K^trans,Kep,Ve and iAUC were 0. 987,0. 885,0. 738,0. 976,among them,the diagnostic efficiency of K^trans is optimum. Conclusion Quantitative classification with magnetic resonance CDT-VIBE imaging technique can be used to differentiate the grade of pathological differentiation of HCC,guide the clinical selection of appropriate treatment and determine prognosis.