MR弹性成像诊断肝细胞癌及评估其病理分化程度

MR elastography for diagnosing and evaluating pathological differentiation of hepatocellular carcinoma

目的观察MR弹性成像(MRE)诊断肝细胞癌(HCC)及评估其病理分化程度的可行性。方法回顾性分析47例经手术(42例)或穿刺(5例)病理证实的原发性HCC患者,包括13例低分化HCC、32例中分化HCC及2例高分化HCC,均接受上腹部MR常规序列平扫、三期增强扫描和MRE;对比HCC与其周围非瘤肝组织,以及低分化与中高分化HCC之间弹性值的差异,绘制受试者工作特征(ROC)曲线,观察弹性值诊断HCC及评估其分化程度的效能。结果HCC弹性值为8.24(7.06,11.42)kPa,高于周围非瘤肝组织的3.46(2.77,4.19)kPa(U=47.000,P<0.001)。低分化HCC弹性值为11.98(10.97,14.89)kPa,中高分化HCC为7.40(6.81,9.23)kPa,差异具有统计学意义(U=384.000,P<0.001)。以4.84 kPa为弹性值的截断值,MRE诊断HCC的ROC曲线下面积(AUC)为0.960,诊断准确率为95.74%(45/47);以10.47 kPa为弹性值的截断值,MRE鉴别低分化与中高分化HCC的AUC为0.869,准确率85.11%(40/47)。结论MRE可用于诊断HCC及评估其病理分化程度。

Objective To explore the value of MR elastography(MRE)for diagnosing and evaluating pathological differentiation of hepatocellular carcinoma(HCC).Methods Data of 47 patients with primary HCC confirmed by surgery(n=42)or biopsy(n=5)were retrospectively analyzed,including 13 cases with low differentiation HCC,32 cases with moderate differentiation HCC and 2 cases with high differentiation HCC.All patients underwent routine MR sequential plain scanning,three-phase enhanced scanning and MRE of the upper abdomen,and the elastic values were compared between HCC lesions and the surrounding non-tumor liver tissue,also between low differentiated HCC and moderate-high differentiated HCC.Receiver operating characteristic(ROC)curves were drawn to analyze the efficacy of elastic values for diagnosing HCC and evaluating the degree of differentiation.Results The elastic value of HCC lesion was 8.24(7.06,11.42)kPa,higher than that of surrounding non-tumor liver tissue(3.46[2.77,4.19]kPa,U=47.000,P<0.001).The elasticity value of low differentiated HCC was 11.98(10.97,14.89)kPa,of moderate-high differentiated HCC was 7.40(6.81,9.23)kPa,there was significantly statistical difference(U=384.000,P<0.001).Taken 4.84 kPa as the cut-off value of the elastic value,the area under the curve(AUC)for diagnosing HCC was 0.960,and the diagnostic accuracy was 95.74%(45/47).Taken 10.47 kPa as the cut-off value of the elastic value,the AUC of differential diagnosis of low and moderate-high differentiated HCC was 0.869,and the accuracy was 85.11%(40/47).Conclusion MRE could be used to diagnose and evaluate the degree of pathological differentiation of HCC.