术前CT检查对孤立性肝细胞癌微血管侵犯的诊断价值

Diagnostic value of preoperative CT for microvascular invasion of solitary hepatocellular carcinoma

目的探究术前CT检查对孤立性肝细胞癌(HCC)微血管侵犯(MVI)的诊断价值。方法抽取2017年6月至2020年6月南阳医学高等专科学校第一附属医院收治的孤立性HCC患者146例为研究对象,根据病理检查结果将其分为MVI组(81例)及非MVI组(65例)。分析两组术前CT征象,采用受试者工作特征曲线(ROC)分析CT征象对MVI的诊断价值。结果 MVI组中肿瘤形态多结节型、肿瘤长径≥5 cm、肿瘤边缘不光滑、无肿瘤包膜、门静脉期CT值≥70 HU、有晕征等患者比例高于非MVI组(P<0.05)。经ROC曲线分析显示,肿瘤边缘不光滑、无肿瘤包膜、有晕征等CT征象联合诊断MVI的曲线下面积大于单一征象(P<0.05)。CT征象联合诊断MVI的灵敏度大于无肿瘤包膜,特异度、准确度大于肿瘤边缘不光滑、无肿瘤包膜(P<0.05)。结论肿瘤边缘不光滑、无肿瘤包膜、有晕征是孤立性HCC患者合并MVI的典型CT征象,对HCC患者合并MVI有一定的诊断价值。

Objective To investigate the diagnostic value of preoperative computed tomography for microvascular invasion(MVI)of solitary hepatocellular carcinoma(HCC).Methods A total of 146 patients with solitary HCC treated in the First Affiliated Hospital of Nanyang Medical College from June 2017 to June 2020 were enrolled as the research objects.According to the results of pathological examination,they were divided into MVI group(81 cases)and non-MVI group(65 cases).The preoperative CT signs in both groups were analyzed.The diagnostic value of CT signs for MVI was analyzed by receiver operating characteristic(ROC)curves.Results The proportions of patients with nodosity tumor morphology,maximum tumor diameter not shorter than 5 cm,rough tumor edge,without tumor capsule,with portal vein CT value not lower than 70 HU,and halo signs in MVI group were higher than those in non-MVI group(P<0.05).ROC curve analysis showed that area under curve of combination of CT signs(rough tumor edge,no tumor capsule,halo signs)in diagnosis of MVI was greater than that of any sign(P<0.05).The sensitivity of combination of CT signs for the diagnosis of MVI was greater than that of no tumor capsule,and the specificity and accuracy of combination of CT signs were greater than those of rough tumor edge and no tumor capsule(P<0.05).Conclusions Rough tumor edge,no tumor capsule,and halo signs are typical CT signs of MVI,and they have certain diagnostic value for MVI.