不同MRI对比剂在预测肝细胞癌微血管侵犯中的应用探究

Exploring the application of different MRI contrast agents in predicting microvascular invasion of hepatocellular carcinoma

目的:基于MRI影像学特征探究肝脏特异性对比剂(Gd-EOB-DTPA)与常规对比剂(Gd-DTPA)在预测肝细胞癌(hepatocellular carcinoma,HCC)微血管侵犯(microvascular invasion,MVI)上的差异。方法:回顾性分析2010年1月—2019年1月行手术治疗的HCC患者253例(Gd-DTPA组121例、Gd-EOB-DTPA组132例)。评估患者术前MRI影像学特征,通过多因素Logistic回归分别建立MVI预测模型,以受试者工作特征曲线及临床决策曲线评估模型效能及差异,并对患者术后生存情况进行随访分析。结果:Gd-DTPA组中病灶大小、边界侵袭征及Gd-EOB-DTPA组中病灶大小、边界侵袭征、卫星灶是预测MVI的独立风险因素。Gd-DTPA组和Gd-EOB-DTPA组模型的曲线下面积(area under curve,AUC)分别为0.761、0.791。临床决策曲线显示Gd-DTPA与Gd-EOB-DTPA在预测MVI发生上具有相近的临床效益。生存分析显示组织病理证实的MVI阳性组与MVI阴性组的平均无疾病生存时间及模型预测的MVI阳性组与MVI阴性组的平均无疾病生存时间均存在显著差异。结论:病灶大小、病灶边界侵袭征及卫星灶是预测MVI的独立危险因素。使用Gd-EOB-DTPA在预测MVI发生方面不能比Gd-DTPA获得更多临床效益,但是Gd-EOB-DTPA具有较高的敏感度。

Objective:This study aims to explore the difference between hepatic-specific contrast agent(Gd-EOB-DTPA)and conventional contrast agent(Gd-DTPA)in predicting microvascular invasion(MVI)of hepatocellular carcinoma(HCC)based on MR imaging features.Methods:A retrospective analysis of 253 patients with HCC who underwent surgical treatment from January 2010 to January 2019(121 cases in Gd-DTPA group and 132 cases in Gd-EOB-DTPA group)were carried out.The preoperative MR imaging features were evaluated,and MVI-prediction models were established through multi-factor logistic regression.Effectiveness and differences of the models were assessed with receiver operating characteristic curves and clinical decision curves.A postoperative survival analysis was also conducted.Results:Lesion size,border invasion in both Gd-DTPA and Gd-EOB-DTPA group,and satellite lesions in Gd-EOB-DTPA group,are independent risk factors for predicting MVI.The area under the curve(AUC)of two models were AUCGD-DTPA:0.761 and AUCGD-EOB-DTPA:0.791,respectively.The clinical decision curve shows that Gd-DTPA and Gd-EOB-DTPA have similar clinical benefits in predicting MVI.Survival analysis illustrated that there were significant difference on the average diseasefree survival time between the MVI-positive group and the MVI-negative group not only confirmed by histopathology but also predicted by the models.Conclusion:Lesion size,border invasion and satellite lesions are independent risk factors for predicting MVI.The application of Gd-EOB-DTPA could not obtain more clinical benefits than Gd-DTPA in predicting MVI,but Gd-EOB-DTPA has a higher sensitivity.