Gd-EOB-DTPA增强MRI对直径≤1 cm HBV相关小肝癌发生肝内转移风险的预测价值

Predictive effect of Gd-EOB-DTPA enhanced MRI for HBV-related diameter ≤1 cm sHCC intrahepatic metastasis

目的探究钆塞酸二钠(gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid,Gd-EOB-DTPA)增强MRI对直径≤1 cm小肝癌(small hepatocellular carcinoma,sHCC)早期转移的预测价值。材料与方法选择无肝内转移且无门静脉主干或一级分支内瘤栓、切缘充分的单发直径≤1 cm肝细胞癌切除标本45例(中位年龄55岁,男性占71.1%),通过中位时间13个月随访,根据是否发生HCC肝内转移分为转移组(n=15)和未转移组(n=30),比较两组临床、影像特征,并通过单因素Kaplan-Meier分析和多因素Cox回归发现HCC肝内转移的危险因素。结果与未转移组相比,转移组在Gd-EOB-DTPA增强MRI图像中,T1WI序列上易表现为低信号(9/60.0%,P=0.042),扩散加权成像(diffusion-weighted imaging,DWI)高信号(12/80.0%,P<0.001),动脉期病灶不均匀强化(10/66.7%,P=0.017),过渡期低信号(12/80.0%,P=0.001)和肝胆特异期低信号(9/60.0%,P=0.016),肝胆特异期极低信号范围多>1/2(14/93.3%,P<0.001)。多因素Cox回归模型校正年龄、性别、分化等级、Edmondson分级后,过渡期低信号(HR=6.19,95%CI:1.7322.16,P=0.005)是HCC转移的独立危险因素。结论Gd-EOB-DTPA增强MRI可以有效预测直径≤1 cm sHCC的肝内转移风险,能为临床早期制定治疗方案提供数据支持。

Objective:To explore the predictive effect of Gd-EOB-DTPA(Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid,Gd-EOB-DTPA)enhanced MRI for metastasis of hepatocellular carcinoma(HCC)with diameter≤1 cm.Materials and Methods:Forty-five patients(median age 55 years old,male 71.1%)without intrahepatic metastasis,without tumor embolus in portal vein trunk and primary branch,with sufficient incisal margin and diameter of≤1 cm were followed up for a median time of 13 months,and were divided into metastatic group(n=15)and non-metastatic group(n=30)according to whether HCC intrahepatic metastasis occurred.Clinical and imaging characteristics between two groups were compared and risk factors of HCC intrahepatic metastasis were determined by univariate Kaplan-Meier analysis and multivariate Cox regression.Results:Compared with the non-metastatic group,HCC with intrahepatic metastasis in the early stage of Gd-EOB-DTPA enhanced MRI images was likely to show hypointensity on T1WI(9/60.0%,P=0.042),hyperintensity on DWI(12/80.0%,P<0.001),homogeneous enhancement in the arterial phase(10/66.7%P=0.017),hypointensity in transitional(12/80.0%,P=0.001)and hepatobiliary phase(9/60.0%,P=0.016);minimal signal>1/2 in hepatobiliary phase(14/93.3%,P<0.001).After adjusting for age,sex,differentiation grade,Edmondson grade in the multivariate Cox model,hypointensity in transitional phase(HR=6.19,95%CI:1.73—22.16,P=0.005)was independent risk factor for HCC intrahepatic metastasis.Conclusions:Gd-EOB-DTPA enhanced MRI has advantages in predicting intrahepatic metastasis of HCC lesions with a diameter≤1 cm.It can provide support for the formulation of therapeutic regimen as soon as possible.