MR功能成像对肝细胞癌微血管侵犯的评估价值

Value of magnetic resonance functional imaging in evaluating microvascular invasion of hepatocellular carcinoma

微血管侵犯作为预测肝细胞癌术后复发的指标目前只能通过"金标准"病理组织学确诊,常规影像学检查方法和血清学指标的检测在微血管侵犯研究中敏感度及特异度均较低,如果术前能够对其作出预测和评估,对于临床治疗方式的选择及患者预后的评估具有重要价值。近年来MR功能成像技术及新型对比剂发展较快,在肝细胞癌早期诊断和术后疗效随访及复发评估方面是研究的热点。简述了利用磁共振扩散加权成像的定量表观扩散系数对肝细胞癌微血管评估的意义,以及体素内不相干运动MR成像、扩散峰度成像新型扩散模型对其评估的潜在价值,同时分析了动态增强磁共振成像及钆塞酸二钠特异性增强MR对肝细胞癌是否存在微血管侵犯及预测其术后复发的应用现状。分析表明MR功能成像技术的发展及部分新技术的应用对肝细胞癌微血管侵犯的评估具有重要价值,可以进一步评估其术后复发及转移的风险,为临床早期诊断、合理采用手术及治疗方式提供可靠的定量评价指标。

Microvascular invasion,as a predictive factor for postoperative recurrence of hepatocellular carcinoma(HCC),can only be diagnosed by the gold standard of pathological histology at present.Conventional imaging examination and serological markers have low sensitivity and specificity in evaluating microvascular invasion.Preoperative prediction and evaluation of microvascular invasion has an important value in selecting clinical treatment and assessing patient diagnosis.In recent years,magnetic resonance(MR)functional imaging and new contrast agents have been developing rapidly and have become the research hotspots in early diagnosis of HCC,postoperative follow-up of treatment outcome,and recurrence evaluation.This article elaborates on the significance of apparent diffusion coefficient of diffusion-weighted magnetic resonance imaging in evaluating microvascular invasion,as well as the potential value of intravoxel incoherent motion-magnetic resonance imaging and a new diffusion model of diffusion kurtosis imaging.This article also analyzes the application of dynamic contrast-enhanced magnetic resonance imaging and Gd-EOB-DTPA-specific MR in evaluating microvascular invasion and predicting postoperative recurrence.The analysis shows that the development of MR functional imaging and the application of several new techniques play an important role in the assessment of microvascular invasion of HCC and can determine the risk of postoperative recurrence and metastasis and provide reliable quantitative assessment indices for early diagnosis and reasonable application of surgery and other treatment methods.