IVIM-DWI联合Gd-EOB-DTPA增强磁共振对肝细胞癌微血管侵犯的预测价值

The value of IVIM-DWI combined with Gd-EOB-DTPA enhanced MRI in prediction of hepatocellular carcinoma microvascular invasion

目的探讨体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion weighted imaging,IVIM-DWI联合钆塞酸二钠(Gd-EOB-DTPA)增强磁共振对肝细胞癌(hepatocellular carcinoma,HCC)微血管侵犯(microvascular invasion,MVI)的预测价值。材料与方法回顾性分析57例经病理学证实的HCC患者的临床和影像学资料。对影像学定性特征包括肿瘤边缘、假包膜、动脉期瘤周强化、肝胆期瘤周低信号等、定量参数包括标准表观扩散系数(standard apparent diffusion coefficient,standard ADC)、真实扩散系数(true diffusion coefficient,D)、伪灌注扩散系数(pseudo-diffusion coefficient,D*)、灌注分数(perfusion fraction,f)、相对增强率(relative enhancement,RE)进行分析。采用卡方检验、独立样本t检验或U检验进行组间比较,对有差异的变量进行多因素Logistic回归分析,采用ROC曲线比较预测MVI有意义指标的诊断效能。结果肿瘤大小、边缘、动脉期瘤周强化、D值等在MVI阳性组与阴性组间差异有统计学意义(P<0.05),其中D值的诊断效能最好(AUC 0.849,敏感度75.0%,特异度81.1%)。多因素Logistic回归分析显示肿瘤大小、动脉期瘤周强化、D值是MVI的独立危险因素。ROC曲线分析显示联合D值与动脉期瘤周强化预测MVI的诊断效能最高(AUC 0.879,敏感度86.5%,特异度80.0%)。结论定量参数D值联合影像学定性特征动脉期瘤周强化可提高预测MVI的准确性,D值越小并伴有瘤周强化的HCC更容易发生MVI。

Objective:To explore the predictive value of intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)combined with Gd-EOB-DTPA enhanced MRI images for hepatocellular carcinoma(HCC) microvascular invasion(MVI).Materials and Methods:The MRI images and clinical data of 57 patients with HCC confirmed by pathology were analyzed retrospectively.Standard ADC value,D value,D*value,f value,relative enhancement(RE) rate and imaging characteristics were analyzed.Chi-square test,t test,and U test were used in the comparison between groups.Multivariate logistic regression analysis was performed on the variables with differences.ROC curves were used to compare the diagnostic efficacy of predicting significant indicators of MVI.Results:There were significant differences in tumor size,margin,peritumor enhancement in arterial phase and D value between MVI positive group and negative group(P<0.05),among which D value had the best diagnostic efficacy(AUC 0.849,sensitivity 75.0%and specificity 81.1%).Multivariate Logistic regression analysis showed that tumor size,arterial peritumor enhancement and D value were independent risk factors for MVI.ROC curve analysis showed that the combination of D value and arterial tumor enhancement had the highest diagnostic efficacy in predicting MVI(AUC 0.879,sensitivity 86.5% and specificity 80.0%).Conclusions:The combination of D value and arterial periodical enhancement can improve the accuracy of predicting MVI.The smaller the D value is,the more likely the HCC with periodical enhancement is to have MVI.