Gd-EOB-DTPA增强MRI T_(1) mapping鉴别不同分化程度肝细胞癌的价值

The Value of Gd-EOB-DTPA Enhanced T mapping in Hepatocellular Carcinoma with Different Degrees of Differentiation

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI T_(1)mapping技术对不同分化程度肝细胞癌(HCC)的鉴别诊断价值。方法搜集2017年7月至2020年5月桂林医学院附属医院经手术病理证实为HCC患者48例共50个病灶,所有患者术前1个月内均进行过Gd-EOB-DTPA增强MRI扫描,采用可变多翻转角T_(1)mapping成像技术,获得增强前、增强后20 min的T_(1)mapping图像。分别测量增强前及增强后20 min的T_(1)弛豫时间T_(1pre)、T_(1post) ,并计算T_(1)弛豫时间减低率(ΔT_(1)%)。根据病理结果,将患者分为3组,高分化HCC 16个,中分化HCC 27个,低分化HCC 7个。采用单因素方差分析比较不同组之间T_(1pre)、T_(1post) 、ΔT_(1)%的差异。采用Spearman等级相关分析评价T_(1pre)、T_(1post) 、ΔT_(1)%与不同分化程度HCC的相关性。采用受试者工作特征曲线(ROC)评估T_(1pre)、T_(1post) 、ΔT_(1)%对不同分化程度HCC的鉴别诊断效能。结果 3组不同分化程度HCC间的T_(1post) 、ΔT_(1)%差异具有统计学意义(P<0.05),T_(1pre)差异无统计学意义(P>0.05)。T_(1post) 和ΔT_(1)%对于鉴别高分化与中分化、高分化与低分化、低分化与中分化HCC的ROC曲线下面积分别为0.752、0.911、0.709,0.775、0.973、0.857;T_(1post) 与HCC的分化程度呈负相关(r值为-0.512,P<0.05),ΔT_(1)%与HCC的分化程度呈正相关(r值为0.614,P<0.05)。ΔT_(1)%的诊断效能更高。结论 Gd-EOB-DTPA增强MRI T_(1)mapping成像对不同分化程度HCC具有鉴别诊断价值,可以作为术前预测HCC病理分级的一种较为可靠的无创检查手段。

Objective To investigate the differential diagnosis value of Gd-EOB-DTPA enhanced MRI T_(1)mapping technique for differently differentiated hepatocellular carcinoma(HCC). Methods A retrospective analysis was performed, of 50 patients with hepatocellular carcinoma confirmed by operation and pathology in the Affiliated Hospital of Guilin Medical College from July 2017 to May 2020.Allpatients underwent Gd-EOB-DTPA enhanced MRI scan within 1 month before surgery. Using variable multiple-flip angle T_(1)mapping imaging technique, obtain T_(1)mapping images before enhancementand 20 min after enhancement, measure the T_(1) relaxation time T_(1) pre and T_(1post) before and 20 min after enhancement, and calculate the T_(1) relaxation time reduction rate(ΔT_(1)%). According to the pathological results, the patients were divided into 3 groups, 16 cases of highly differentiated HCC, 27 cases of moderately differentiated HCC, and 7 cases of poorly differentiated HCC. One-way analysis of variance was used to compare the differences of T_(1) pre, T_(1post) , and ΔT_(1)% between different groups. Spearman rank correlation analysis was used to evaluate the correlation between T_(1) pre, T_(1post) , ΔT_(1)% and HCC with different degrees of differentiation. The receiver operating characteristic curve(ROC) was used to evaluate the differential diagnosis efficacy of T_(1) pre, T_(1post) , and ΔT_(1)% for HCC with different levels of differentiation. Results There were statistically significant differences in T_(1post) and ΔT_(1)% among the three groups of HCC with different levels of differentiation(P<0.05), but there was no statistically significant difference in T_(1) pre(P>0.05). The area under the ROC curve of T_(1post) and ΔT_(1)% for differentiating well-differentiated and moderately differentiated, well-differentiated and poorly-differentiated, poorly-differentiated and moderately differentiated HCC are 0.752, 0.911, 0.709, 0.775, 0.973, 0.857, respectively. The degree of differentiation between T_(1post) and HCC is negatively correlated(r value-0.512, P<0.05). ΔT_(1)% was positively correlated with HCC differentiation(r value 0.614, P<0.05). The diagnostic efficiency of ΔT_(1)% is higher. Conclusion Gd-EOB-DTPA-enhanced MRI T_(1) mapping imaging has valuein differential diagnosis of HCC with different levels of differentiation, and can be used as a more reliable non-invasive investigative method to predict the pathological grade of HCC before operation.