增强磁共振成像联合血清肿瘤标志物对肝细胞癌肿瘤结节的诊断价值

Diagnostic value of enhanced MRI combined with serum tumor markers for hepatocellular carcinoma nodules

目的探讨增强磁共振成像(MRI)联合血清甲胎蛋白(AFP)、高尔基蛋白73(GP73)和脱-γ-羧基凝血酶原(DCP)对肝细胞癌肿瘤结节的诊断价值。方法选取2017年5月至2020年5月间陕西省肿瘤医院收治的62例疑似肝细胞癌肿瘤结节患者,均采用增强MRI扫描,以术后病理学检查作为金标准,分为阳性组52例和阴性组10例。分析增强MRI扫描结果,比较两组患者AFP、GP73和DCP水平,绘制ROC曲线分析增强MRI联合血清AFP、GP73和DCP检测对肝细胞癌肿瘤结节的诊断价值。结果术后病理学检查发现,52例患者存在肝细胞癌肿瘤结节,10例患者为良性肝细胞结节。MRI扫描发现,44例患者为肝细胞癌肿瘤结节,18例患者为良性肝细胞结节。病例患者中可见肝内弥漫性细小颗粒状结节,通常为0.3~1.0cm,T1WI表现为略高或等信号,T2WI表现为略低信号,周围可发现略高信号的间隔隔开结节。其中31例患者图像中可见弥散性细小颗粒状结节,背景内混合2.5cm左右的大结节,T1WI信号表现为略高或相等信号,T2WI表现为相等信号。13例患者在弥漫性结节背景内可发现直径<3.0mm的结节,T1WI表现为低信号,T2WI表现为略高信号及结节状病灶阴影,同时给予增强MRI发现,T2WI表现为相等或略低信号,在动态增强扫描内与肝组织同步增强或减退。阳性组患者血清AFP、GP73和DCP检测水平较阴性组更高,差异均有统计学意义(均P<0.05)。MRI-DWI、血清AFP、GP73和DCP联合诊断肝细胞癌肿瘤结节的灵敏度、特异度及准确率均高于各项单一检测。结论增强MRI联合血清AFP、GP73和DCP检测对肝细胞癌肿瘤结节的诊断价值较高,值得临床推广。

Objective To study the diagnostic value of enhanced magnetic resonance imaging(MRI) combined with serum alpha-fetoprotein(AFP), Golgi protein 73(GP73) and des-gamma-carboxy prothrombin(DCP) for hepatocellular carcinoma nodules. Methods Sixty-two patients with suspected hepatocellular carcinoma nodules who underwent enhanced MRI scans were selected at Shaanxi Cancer Hospital from May 2017 to May 2020. The postoperative pathological examination was used as the gold standard to divide the patients into a positive group(52 patients) and a negative group(10 patients). The results of enhanced MRI scans were analyzed to compare the levels of AFP, GP73, and DCP between the positive and negative groups. Receiver operating characteristic(ROC) curves were drawn to analyze the diagnostic value of enhanced MRI combined with serum AFP, GP73 and DCP for hepatocellular carcinoma nodules. Results The pathological examination after the operation showed that 52 patients had hepatocellular carcinoma nodules and 10 patients had benign hepatocyte nodules. MRI scans revealed that 44 patients had hepatocellular carcinoma nodules and 18 patients had benign hepatocyte nodules. Diffuse nodular of 0.3 cm to 1.0 cm was displayed in the positive group. T1 WI showed slightly high or equal signal intensity and T2 WI demonstrated slightly low signal intensity with paracancerous nodular separated by internodular space. Thirty-one patients had diffuse nodular complicated with large size nodular of about 2.5 cm with slightly high or equal signal intensity on T1 WI and equal signal intensity on T2 WI and paracancerous nodular separated by internodular space was observed. Thirteen patients had nodular which was less than 3.0 cm in the background of diffuse nodular. On the T1 WI, the lesion showed low signal intensity and on the T2 WI, it showed slightly high signal intensity and nodular shadows. On enhanced MRI, T2 WI revealed equal or elevated signal intensity which varied with liver tissues on dynamic contrast scan. Compared with the negative group, the positive group had significantly higher serum AFP, GP73, and DCP levels(all P<0.05). The sensitivity, specificity and accuracy of the combined MRI scan and serum AFP, GP73 and DCP test were significantly higher than those of the each one alone for hepatocellular carcinoma nodules. Conclusion Enhanced MRI combined with serum AFP, GP73 and DCP has a high diagnostic value for hepatocellular carcinoma tumor nodules, and it is worthy of clinical promotion.