钆塞酸二钠增强MRI对肝细胞癌微血管侵犯及其分级的预测价值

The value of Gd-EOB-DTPA enhanced MRI in predicting microvascular invasion of hepatocellular carcinoma and its grade

目的评价钆塞酸二钠(gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid,Gd-EOB-DTPA)增强MRI对肝细胞癌(hepatocellular carcinoma,HCC)微血管侵犯(microvascular invasion,MVI)发生及分级的预测价值。材料与方法对67例经术后病理证实为原发性HCC的患者进行回顾性研究,将所有病例根据有无微血管侵犯划分为MVI阳性组和MVI阴性组,分析患者的一般资料及实验室检查、Gd-EOB-DTPA增强MRI影像学资料及术后肿瘤病理组织学分级资料,得出影响HCC患者MVI的独立危险因素;随后绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估独立危险因素的诊断效能。进一步将所有HCC患者根据MVI分级分为M0组、M1组、M2组,研究单因素分析结果中P<0.05的指标对MVI分级的影响。结果单因素分析结果显示MVI阳性组和MVI阴性组在肿瘤边缘、动脉期瘤周强化、动脉期瘤周高信号环、肝胆期瘤周低信号等方面的差异有统计学意义(P<0.05);进一步多因素二元Logistic回归分析结果显示动脉期瘤周高信号环、肝胆期瘤周低信号为影响HCC MVI发生的独立危险因素。独立危险因素诊断效能分析结果显示,动脉期瘤周高信号环及肝胆期瘤周低信号ROC曲线下面积(area under the curve,AUC)分别为0.669、0.636,动脉期瘤周高信号环敏感度、特异度分别为93.8%、40.0%,肝胆期瘤周低信号敏感度、特异度分别为84.4%、42.9%。研究结果显示动脉期瘤周高信号环、肝胆期瘤周低信号及肿瘤边缘情况在MVI不同分级之间的差异有统计学意义,且从数据中可以看出,MVI级别越高,动脉期瘤周高信号环及肝胆期瘤周低信号发生的概率越大。结论 Gd-EOB-DTPA增强MRI中,动脉期瘤周高信号环、肝胆期瘤周低信号可作为术前预测肝癌微血管侵犯发生有效指标;而动脉期瘤周高信号环、肝胆期瘤周低信号及肿瘤边缘在预测HCC MVI分级方面有意义。

Objective:To evaluate the predictive value of Gd-EOB-DTP-enhanced MRI in the occurrence and grading of microvascular invasion of(MVI) in hepatocellular carcinoma(HCC).Materials and Methods:Sixty-seven patients with primary HCC confirmed by postoperative pathology were retrospectively studied.All cases were divided into MVI positive group and MVI negative group according to whether there was microvascular invasion or not.The general data and laboratory examination,Gd-EOB-DTPA enhanced MRI imaging data and postoperative tumor histopathological grading data were analyzed,and the independent risk factors affecting microvascular invasion in patients with hepatocellular carcinoma were obtained.ROC curve was drawn to evaluate the diagnostic efficacy of independent risk factors.Furthermore,according to the histological characteristics of microvascular invasion,all patients with hepatocellular carcinoma were divided into M0 group,M1 group and M2 group.The effect of P<0.05 in univariate analysis on MVI grade was studied.Results:Univariate analysis showed that there were significant differences in tumor margin、 rim enhancement、peritumoral enhancement in arterial phase and peritumoral hypointensity in the hepatobiliary phase between MVI positive group and MVI negative group.Further multivariate Logistic regression analysis showed that peritumoral enhancement in the arterial phase and peritumoral hypointensity in the hepatobiliary phase were independent risk factors for the occurrence of MVI in hepatocellular carcinoma.The results of diagnostic effectiveness analysis of independent risk factors showed that the area under the curve(AUC) of peritumoral enhancement in the arterial phase and peritumoral hypointensity in the hepatobiliary phase were 0.669 and 0.636,respectively.The sensitivity and specificity of peritumoral enhancement in the arterial phase were 93.8% and 40.0%,respectively,and the sensitivity and specificity of peritumoral hypointensity in the hepatobiliary phase were 84.4% and 42.9%,respectively.Furthermore,all patients with hepatocellular carcinoma were divided into M0 group,M1 group and M2 group according to MVI grade.The results showed that there were significant differences in peritumor rim enhancement in arterial phase,low signal intensity in hepatobiliary phase and tumor margin among different MVI grades,and it can be seen from the data that the higher the MVI grade,the greater the proportion of peritumoral enhancement in the arterial phase and peritumoral hypointensity in the hepatobiliary phase.Conclusions:In Gd-EOB-DTPA enhanced MRI,peritumoral enhancement in the arterial phase and peritumoral hypointensity in the hepatobiliary phase can be used as effective indexes to predict microvascular invasion of HCC before operation,while peritumoral enhancement in the arterial phase and peritumoral hypointensity in the hepatobiliary phase and tumor margin can be used to predict MVI grade of HCC.