最小表观扩散系数值在评估肝细胞性肝癌侵袭性中的价值

The value of minimum apparent diffusion coefficient in evaluating the invasiveness of hepatocellular carcinoma

目的使用最小表观扩散系数值(minimum ADC,ADCmin)评估肝细胞性肝癌(hepatocellular carcinoma,HCC)的侵袭性。材料与方法回顾性分析2015年1月至2020年10月经病理证实并在术前接受MRI扩散加权成像(diffusion weighted imaging,DWI)检查的85名HCC患者,记录其临床及病理信息并在表观扩散系数(apparent diffusion coefficient,ADC)图像上测量肿瘤的ADCmin。采用统计学方法评估患者的临床信息、ADCmin与微血管侵犯(microvascular invasion,MVI)、分化程度和Ki-67表达的相关性。二元Logistic回归筛选出与HCC侵袭性相关的独立因素,采用受试者操作特征(receiver operating characteristic,ROC)曲线评价其诊断效能。结果研究表明,肿瘤大小与HCC MVI及分化程度有关(P<0.05)。MVI两组间ADCmin差异具有统计学意义(0.87±0.15与1.14±0.24,P<0.05),应用ADCmin判断MVI的AUC值为0.866(95%CI,0.770~0.962);分化程度两组间ADCmin差异具有统计学意义(0.91±0.18与1.09±0.25,P<0.05),应用ADCmin预测HCC分化程度的AUC值为0.739(95%CI,0.608~0.870);Ki-67两组间ADCmin差异具有统计学意义(1.19±0.24与1.03±0.25,P<0.05),应用ADCmin预测Ki-67的AUC值为0.723(95%CI,0.576~0.871)。结论本研究表明,ADCmin在术前无创性评估HCC的侵袭性中具有较大临床价值,可极大改善患者预后。

objective:To evaluate the invasiveness of hepatocellular carcinoma(HCC)by using the minimum apparent diffusion coefficient(ADCmin).Materials and Methods:The 85 patients with HCC confirmed by pathology and examined by MRI diffusion weighted imaging(DWI)before operation from January 2015 to October 2020 were analyzed retrospectively.The clinical and pathological information were recorded and the tumor ADCminwas measured on ADC images.Statistical methods were used to evaluate the correlation between clinical information,ADCminand microvascular invasion(MVI),histological differentiation and Ki-67 expression.The independent factors related to the invasiveness of HCC were screened by binary Logistic regression,and the diagnostic efficiency was evaluated by ROC curve.Results:The size of tumor was related to HCC MVI and the histological differentiation(P<0.05).The difference of ADCminbetween the two groups in MVI were statistically significant(0.87±0.15 vs.1.14±0.24,P<0.05).The AUC value of MVI judged by ADCmin was 0.866(95%CI,0.770—0.962).The difference of ADCmin between the two groups in histological differentiation were statistically significant(0.91±0.18 vs.1.09±0.25,P<0.05),and the AUC value of using ADCmin to predict the degree of HCC differentiation was 0.739(95%CI,0.608—0.870).There were significant difference in ADCmin between the two groups of Ki-67(1.19±0.24 vs.1.03±0.25,P<0.05).The AUC value of Ki-67 predicted by ADCmin was 0.723(95%CI,0.576—0.871).Conclusion:This study showed that ADCminhad great clinical value in preoperative non-invasive evaluation of the invasiveness of HCC and can greatly improve the prognosis of patients.