Gd-EOB-DTPA增强磁共振成像联合DWI在评估肝细胞癌微血管侵犯与其预后中的评估价值比较

Comparison of the Evaluation Value of Gd-EOB-DTPA-enhanced Magnetic Resonance Imaging and DWI in Evaluating Microvascular Invasion and Prognosis of Hepatocellular Carcinoma

目的:比较钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)联合DWI在肝细胞癌(HCC)微血管侵犯(MVI)与其预后中的评估价值。方法:回顾性选取2018年5月-2020年6月咸宁市第一人民医院收治的68例HCC患者,均于术前7 d内予以Gd-EOB-DTPA MRI增强扫描及DWI检查,依据术后病理结果将其分为MVI组、非MVI组,比较两组影像学资料及表观扩散系数(ADC)值,并分析各参数对MVI、预后的预测价值。结果:68例患者中,MVI阳性21例(30.88%);MVI组肿瘤直径、肿瘤边缘不光滑、动脉期瘤周强化、肝胆特异期瘤周低信号高于非MVI组,MVI组ADC值低于非MVI组(P<0.05);Gd-EOB-DTPA增强MRI联合DWI判断MVI的曲线下面积、敏感度、特异度、准确度分别为0.875、85.71%、89.36%,均高于单独Gd-EOB-DTPA增强MRI(0.753、76.19%、74.47%、75.00%)、单独DWI(0.716、66.67%、76.60%、73.52%),其中准确度比较差异有统计学意义(P<0.05);肿瘤边缘不光滑、动脉期瘤周强化、ADC值低为判断HCC患者肝动脉化疗栓塞术(TACE)后复发的独立影响因素(P<0.05)。结论:Gd-EOB-DTPA增强MRI联合DWI中,动脉期瘤周强化、肿瘤边缘不光滑、肝胆特异期瘤周低信号、ADC值等对HCC患者MVI有重要判断价值,且对患者TACE术后预后有判断价值,可用于术后随访。

Objective:To compare the evaluation value of Gadoxetate Disodium(Gd-EOB-DTPA)magnetic resonance imaging(MRI)and DWI in hepatocellular carcinoma(HCC)microvascular invasion(MVI)and its prognosis.Method:A retrospective selection of 68 patients with HCC admitted to the First People’s Hospital of Xianning City from May 2018 to June 2020 were all performed Gd-EOBDTPA-enhanced MRI scan and DWI examination within 7 days before surgery,based on the postoperative pathological results,they were divided into MVI group and non-MVI group,compared the imaging data and apparent diffusion coefficient(ADC)values of the two groups,and analyzed the predictive value of each parameter to MVI and prognosis.Result:Of the 68 patients,21 cases(30.88%)were positive for MVI;tumor diameter,tumor margin is not smooth,arterial peritumoral enhancement,hepatobiliary-specific peritumoral hypointensity in the MVI group were higher than those in the non-MVI group,and ADC values in the MVI group were lower than those in the non-MVI group(P<0.05).The area under the curve,sensitivity,specificity,and accuracy of Gd-EOB-DTPA-enhanced MRI combined with DWI in judging MVI were 0.875,85.71%,89.36%,respectively,which were higher than those of Gd-EOB-DTPA-enhanced MRI(0.753,76.19%,74.47%,75.00%),DWI alone(0.716,66.67%,76.60%,73.52%),the difference in accuracy was statistically significant(P<0.05);tumor margin is not smooth,arterial peritumoral enhancement,and low ADC value were independent influence factors for recurrence after hepatic artery chemoembolization(TACE)in HCC patients(P<0.05).Conclusion:In Gd-EOB-DTPA-enhanced MRI combined with DWI,arterial peritumoral enhancement,tumor margin is not smooth,hepatobiliary-specific peritumoral hypointensity,ADC value,etc.have important judgment value for MVI in HCC patients,and the prognosis of patients after TACE.It has judgment value and can be used for postoperative follow-up.