基于Gd-EOB-DTPA增强的T1值预测肝癌病理分级的初步研究

Preliminary Study on Predicting the Pathological Grade of Hepatocellular Carcinoma Based on T1 Value Enhanced by Gd-EOB-DTPA

目的使用钆塞酸二钠(Gd-EOB-DTPA)增强前、后的T1值,联合患者的临床实验室检查及常规MR图像的定性及定量指标,以期找到有效的术前预测肝癌病理分级的方法。方法回顾性分析2015年7月至2017年9月术前于本院行Gd-EOB-DTPA增强磁共振检查的肝脏局灶性病变患者437例,最终67例肝细胞癌(HCC)患者被纳入本研究。同时记录患者的临床资料,包括年龄,性别,肝脏病史,肝炎病史以及甲胎蛋白(AFP)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)及肝功能指标。连续性变量采用独立t检验;分类变量采用卡方或Fisher检验进行统计。结果低级别组HCC的Gd-EOB-DTPA增强前T1值(1080.6±240.1)ms,增强后肝胆特异期T1值为(571.1±190.1)ms,T1值衰减率(△)为0.48±0.11;高级别组HCC的Gd-EOB-DTPA增强前T1值为(1121.8±317.1)ms,增强后肝胆特异期T1值为(639.4±135.2)ms,△为0.41±0.11,两者之间存在统计学差异(P=0.0175)。低级别与高级别HCC患者的年龄、性别、AFP水平、肝脏病史(肝硬化、乙型肝炎)、术前肝功能检查均不存在统计学差异。低级别与高级别HCC组之间存在统计学差异的MR定性征象为肿瘤的边界(P=0.007)。结论肿瘤的边界以及Gd-EOB-DTPA增强△可以用来区分低级别与高级别HCC。

Objective To measure the T1 value before and after using disodium acetoate(Gd-EOB-DTPA),combined with the clinical laboratory examination of patients and the qualitative and quantitative indicators of conventional MR ima-ges,in order to find an effective preoperative prediction of liver cancer pathological grade.Methods From July 2015 to September 2017,437 patients who underwent magnetic resonance imaging with Gd-EOB-DTPA injection in our department before surgery were enrolled.Finally,the 67 HCC patients were included in the study.The patient's clinical data were also recorded,including age,gender,liver background disease,hepatitis history,and alpha-fetoprotein,carbohydrate anti-19-9,carcinoembryonic antigen,and liver function indicators.The continuous variables were tested by independent t test;the cat-egorical variables were statistically analyzed using chi-square or Fisher test.Results The Gd-EOB-DTPA value of HCC in the low-level group before enhancement was 1080.6±240.1 ms,and the T1 value of the hepatobiliary specific period after enhancement was(571.1±190.1)ms,and the T1 value decay rate(%)was 0.48±0.11.in the high-level group The Gd-EOB-DTPA T1 value of HCC before enhancement was(1121.8±317.1)ms,the T1 value of hepatobiliary specific phase after enhancement was 639.4±135.2 ms,and the decay rate(%)of T1 value was 0.41±0.11.There was sta-tisticaldifference between the two parameters(P=0.0175).There was no statistical differences in the age,gender,AFP level,liver background disease(cirrhosis,hepatitis B),and preoperative liver function tests in patients with low-grade and high-grade HCC.The qualitative sign of MR that was statistically different between the low-grade and high-grade HCC groups was the tumor boundary(P=0.007).Conclusion The tumor boundary and the rate of Gd-EOB-DTPA-enhanced T1 attenuation can be used to distinguish between low-grade and high-grade HCC.