磁共振扩散加权成像对肝细胞癌微血管侵犯的诊断价值

Diagnostic value of diffusion-weighted magnetic resonance imaging in microvascular invasion of hepatocellular carcinoma

目的探讨磁共振扩散加权成像(DWI)对肝细胞肝癌患者微血管侵犯的诊断价值。方法对84例肝细胞肝癌患者进行常规磁共振成像(MRI)和MRI-DWI扫描,以病理诊断结果为金标准,分析表观扩散系数(ADC)值对肝细胞肝癌患者微血管侵犯情况的诊断价值,并分析各ADC值与肝细胞肝癌患者分化程度的相关性。结果病理诊断结果显示,84例肝细胞肝癌患者中微血管侵犯阳性31例,阴性53例。微血管侵犯阳性和阴性肝细胞肝癌患者的性别、年龄、Child分级、肝硬化情况、甲胎蛋白(AFP)水平、肿瘤部位和肿瘤直径比较,差异均无统计学意义(P﹥0.05);血管侵犯阳性和阴性肝细胞肝癌患者分化程度比较,差异有统计学意义(P﹤0.05)。微血管侵犯阳性和阴性肝细胞肝癌患者的平均ADC值(ADCmean值)比较,差异无统计学意义(P﹥0.05);微血管侵犯阳性肝细胞肝癌患者的ADC值(ADCmin值)明显低于微血管侵犯阴性患者,差异有统计学意义(P﹤0.01)。受试者工作特征(ROC)曲线分析结果显示,ADCmin值诊断微血管侵犯阳性的曲线下面积(AUC)为0.848,灵敏度、特异度分别80.00%、88.70%,最佳诊断值为0.959×10-3mm2/s。ADCmin值与肝细胞肝癌患者的分化程度呈负相关(r=-0.644,P﹤0.01)。结论ADCmin值有助于评估肝细胞肝癌患者微血管侵犯情况,其与肝细胞肝癌患者的分化程度呈负相关,为肝细胞肝癌患者病情及预后的判断提供了理论依据。

Objective To investigate the predictive value of diffusion-weighted imaging(DWI)in microvascular invasion of hepatocellular carcinoma(HCC).Method 84 patients with HCC were scanned by conventional magnetic resonance imaging(MRI)and MRI-DWI.The diagnostic value of apparent diffusion coefficient(ADC)in microvascular invasion of HCC patients was analyzed with pathological diagnosis results as gold standard.The correlation between ADC values and differentiation degree of HCC and microvascular invasion was analyzed.Result Pathological diagnosis showed that 31 cases were positive for microvascular invasion and 53 cases were negative.There was no significant difference in gender,age,child grade,liver cirrhosis,α-fetal protein(AFP)level,tumor location and tumor diameter between patients with positive and negative microvascular invasion(P>0.05).There was significant difference in the degree of differentiation between patients with positive and negative vascular invasion(P<0.05).Tumor-ADCmin in microvascular invasion in the positive group was significantly lower than that in microvascular negative invasion group(P<0.01).receiver operating characteristic(ROC)curve analysis showed that the positive area under curve(AUC)of ADCmin was 0.848.The sensitivity and specificity were 80.00%and 88.70%respectively when the best diagnostic value was 0.959×10-3mm2/s.ADCmin was negatively correlated with the degree of differentiation of HCC patients(r=-0.644,P<0.01).Conclusion Tumor-ADCmin value is helpful in evaluating microvascular invasion in HCC patients which is negatively correlated with the degree of differentiation in patients with hepatocellular carcinoma.It provides important reference for clinical practice.