检验指标及影像特征预测肝细胞癌微血管侵犯的初步研究

Preliminary study of test indexes and imaging features to predict microvascular invasion of hepatocellular carcinoma

目的探讨检验指标及影像学特征预测肝细胞癌微血管侵犯的应用价值。方法选取2019年1月至2021年12月在南方医科大学顺德医院行肝脏切除术的119例患者作为研究对象,根据手术病理结果的微血管侵犯(MVI)情况将其分为MVI阳性组(49例)和MVI阴性组(70例)。所有患者术前均行核磁共振成像(MRI)检查,分析肝细胞癌微血管侵犯的影响因素。结果两组患者NLR、PT、肿瘤累及的肝段、影像学形态、马赛克征、坏死、出血、DWI表现、动脉期瘤周强化、瘤内动脉、冠状强化、HBP瘤周低信号、肿瘤直径比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,NLR水平升高、PT低、有肿瘤累计的肝段、肿瘤直径长是影响预测肝细胞癌MVI的独立危险因素(P值均<0.05)。ROC曲线图显示,HBP瘤周低信号对肝细胞癌MVI诊断效能最大,曲线下面积为0.809。结论临床上可通过NLR、PT、肿瘤累计的肝段、肿瘤直径等联合检查判断肝细胞癌患者MVI情况。

Objective To explore the application value of test indexes and imaging features in predicting microvascular invasion of hepatocellular carcinoma.Methods A total of 119 patients who underwent hepatectomy in Shunde Hospital of Southern Medical University from January 2019 to December2021 were selected as the research subjects.They were divided into the MVI positive group(49 cases)and the MVI negative group(70 cases)according to the microvascular invasion(MVI)of the surgical and pathological results.All patients underwent preoperative magnetic resonance imaging(MRI)examination to analyze the influencing factors of microvascular invasion of hepatocellular carcinoma.Results There were statistically significant differences in NLR,PT,liver segment affected by tumor,imaging morphology,mosaic sign,necrosis,hemorrhage,DWI appearance,peritumoral enhancement,intratumoral artery,coronary enhancement,HBP peritumoral low signal,and tumor diameter between the two groups(P<0.05).Logistic regression analysis showed that increased NLR level,low PT,liver segments with tumor accumulation,and long tumor diameter were independent influencing factors for predicting MVI in hepatocellular carcinoma(P<0.05).The ROC curve showed that the HBP peritumoral hypointensity had the greatest diagnostic performance for MVI in hepatocellular carcinoma,and the area under the curve was 0.809.Conclusion Clinically,the MVI status of patients with hepatocellular carcinoma can be judged by combined examinations such as NLR,PT,accumulated liver segments of the tumor,and tumor diameter.