增强CT影像学征象联合判断肝细胞癌微血管侵犯的价值研究

Exploration on the value of the combined judgement of contrast-enhanced CT imaging signs for the MVI of HCC

目的:分析增强多层螺旋CT(MSCT)影像学征象联合判断肝细胞癌(HCC)微血管侵犯(MVI)的价值。方法:选取因肝细胞癌行根治性切除手术的256例患者术前临床及影像学资料,根据病理检查结果的MVI情况将其分为MVI组(111例)和非MVI组(145例),所有患者术前均行MSCT检查,比较两组患者中性粒细胞(NE)、血小板(PLT)、红细胞(RBC)、碱性磷酸酶(ALP)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、甲胎蛋白(AFP)和糖类抗原199(CA199)水平及MSCT相关指标,采用Logistic回归分析预测MVI的独立危险因素;采用受试者工作特征曲线(ROC)分析MSCT诊断MVI的价值。结果:MVI组患者NE、PLT、RBC、ALP、AST、GGT及CA199水平均高于非MVI组,AFP水平明显低于非MVI组,差异有统计学意义(t=2.150,t=2.748,t=5.239,t=2.217,t=2.110,t=2.460,t=5.697,t=9.764;P<0.05)。两组患者肿瘤边缘、瘤内动脉、晕环、包膜、坏死及卫星结节等情况差异有统计学意义(χ^(2)=37.636,χ^(2)=54.882,χ^(2)=18.083,χ^(2)=26.725,χ^(2)=14.139,χ^(2)=7.685;P<0.05);MVI组患者肿瘤直径、体积、门静脉期CT值及延迟期CT值水平明显高于非MVI组,差异有统计学意义(t=5.485,t=3.928,t=6.180,t=5.884;P<0.05),动脉期CT水平明显低于非MVI组,差异有统计学意义(t=3.722,P<0.05)。多因素Logistic回归分析中肿瘤坏死、包膜、瘤内动脉、晕环、卫星结节及边缘情况是预测MVI的独立危险因素(OR=1.495,OR=0.429,OR=3.641,OR=0.337,OR=1.886,OR=2.214;P<0.05)。以病理诊断结果为金标准,MSCT诊断MVI的灵敏度为91.30%,特异度为95.74%,准确率为93.75%。结论:MSCT可通过肿瘤坏死、包膜、瘤内动脉、晕环、卫星结节及边缘等联合判断HCC患者MVI情况,MSCT诊断MVI具有一定价值。

Objective:To analyze the value of combined judgement of contrast-enhanced multi spiral computed tomography(MSCT) imaging signs for microvascular invasion(MVI) of hepatocellular carcinoma(HCC).Methods:The preoperatively clinical and imaging data of 256 patients who underwent radical resection of HCC were selected.And these patients were divided into MVI group(111 cases) and non-MVI group(145 cases) according to the MVI status of pathological examination results.All patients underwent preoperative MSCT examination.The neutrophil(NE),blood platelet(PLT),red blood cell(RBC),alkaline phosphatase(ALP),aspartic transaminase(AST),γ-glutamyltransferase(GGT),alpha fetoprotein(AFP) and carbohydrate antigen 199(CA199) and the relative indicators o MSCT between two groups were compared.And the Logistic regression analysis was adopted to predict the independent risk factor of MVI,and the receiver operating characteristics(ROC) was adopted to analyze the value of MSCT in diagnosing MVI.Results:The NE,PLT,RBC,ALP,AST,GGT and CA199 levels of MVI group were significantly higher than those of non-MVI group(t=2.150,t=2.748,t=5.239,t=2.217,t=2.110,t=2.460,t=5.697,P<0.05),while the AFP level of MVI group was significantly lower than that of non-MVI group(t=9.764,P<0.05).There were significant differences in tumor margin,intratumoral artery,halo,capsule,necrosis and satellite nodules between the two groups(χ^(2)=37.636,χ^(2)=54.882,χ^(2)=18.083,χ^(2)=26.725,χ^(2)=14.139,χ^(2)=7.685,P<0.05).The tumor diameter,volume,CT value in portal venous phase and CT value in delayed phase of MVI group were significantly higher than those of non-MVI group(t=5.485,t=3.928,t=6.180,t=5.884,P<0.05).The CT level in arterial phase of MVI group was significantly lower than that of non-MVI group,and the difference of that between two groups was statistically significant(t=3.722,P<0.05).The results of multivariate logistic regression analysis showed that tumor necrosis,capsule,intratumoral artery,halo,satellite nodules and border conditions were independent risk factors in predicting MVI(OR=1.495,OR=0.429,OR=3.641,OR=0.337,OR=1.886,OR=2.214,P<0.05).As the gold standard which was the results of pathological diagnosis,the sensitivity,specificity and accuracy of MSCT was 91.30%,95.74% and 93.75% in diagnosing MVI.Conclusion:MSCT can judge the MVI of HCC patients by the combined judgement of tumor necrosis,capsule,intratumoral artery,halo,satellite nodules and margins.MSCT has a certain of value in diagnosing MVI.