钆塞酸二钠MRI增强预测HCC病理分级可行性的探讨

Feasibility of gadoxetate disodium-enhanced MRI in predicting pathological grading of HCC

目的探讨基于钆塞酸二钠MRI增强预测HCC病理分级的可行性。方法收集2017年1月~2020年5月62例经手术证实为原发性肝细胞肝癌的病例,根据2019年消化系统肿瘤WHO分级法行分组[1],对其普美显MR增强图像进行回顾性分析,测量平扫(T1WI)、肝胆期灰阶值及灰阶强化比值,得出强化程度率,探讨基于钆塞酸二钠MRI增强HCC病灶强化程度率与病理分级之间的关联。结果 62例病例中,低分化22例,中分化20例,高分化20例,低分化组肝胆期强化程度0.06±0.03,中分化组肝胆期强化程度0.10±0.06,高分化期强化程度为0.16±0.06,均有显著性差异(P <0.05),强化程度率高分化组>中分化组>低分化组,其中高分化组均值比中分化组高0.06,中分化组均值比低分化组高0.04。不同分化程度的HCC病灶肝胆期强化灰阶比值存在明显的组间差异(P <0.05),肿瘤分化程度越高肝胆期强化灰阶比值越大。结论基于钆塞酸二钠MRI增强HCC病灶肝胆期强化程度灰阶比值对预测病理分级具有参考价值。

Objective To explore the feasibility of gadoxetate disodium-enhanced MRI in predicating the pathological grading of HCC.Methods A total of 62 cases that were confirmed with primary hepatocellular carcinoma(HCC)by surgery from January 2017 to May 2020 were collected,and grouped according to 2019 WHO classification of digestive system tumors.Retrospective analysis was performed on their Gd-EOB-DTPA-enhanced MR images.The non-enhanced(T1WI)and enhanced gray-scale ratio of hepatobiliary phase was measured respectively to calculate the enhancement rate.The correlation between the enhancement rate and the pathological grading of HCC on the basis of gadoxetate disodiumvenhanced MRI was explored.Results There were 22 cases with poor differentiation,20 cases with moderate differentiation and 20 with high differentiation among the 62 cases.The degree of hepatobiliary phase enhancement was 0.06±0.03 in the poor differentiation group,0.1±0.06 in the moderate differentiation group,and 0.16±0.06 in the high differentiation group;there were significant differences among the three groups.The enhancement rate of the high differentiation group was higher than that of the moderate differentiation group,higher than that of the poor differentiation group.The mean of the high differentiation group was 0.06 higher than that of the moderate differentiation group;the mean of the moderate differentiation group was 0.04 higher than that of the poor differentiation group.There were significant differences among groups in the gray-scale ratio of enhanced hepatobiliary phase in HCC with different degrees of differentiation(P<0.05).The higher degree of tumor differentiation was associated with higher gray-scale value of enhanced hepatobiliary phase.Conclusion The degree of hepatobiliary phase enhancement and gray-scale ratio of HCC on the basis of gadoxetate disodium-enhanced MRI have reference value in predicting the pathological grading.