体素内不相干运动成像在预测肝癌微血管侵犯中的价值

The value of intravoxel incoherent motion imaging in predicting microvascular invasion of hepatocellular carcinoma

目的:探讨体素内不相干运动成像(IVIM)在预测肝细胞肝癌(HCC)微血管侵犯(MVI)中的价值。方法:回顾性纳入经手术病理证实为HCC的104例患者,并分为MVI阳性组和MVI阴性组。所有患者术前均完成了单b值DWI、多b值IVIM及增强扫描。测量HCC患者DWI参数表观扩散系数(ADC)及IVIM参数扩散系数(D)、灌注相关扩散系数(D*)和灌注分数(f)。比较MVI阳性组和阴性组DWI和IVIM参数的差异。采用Logistic回顾分析预测MVI阳性的独立危险因素,同时采用受试者操作特征(ROC)曲线评估差异有统计学意义的参数对MVI的预测效能。结果:在104例HCC中,MVI阳性57例,MVI阴性47例;MVI阳性组的ADC值和D值均低于MVI阴性组(P<0.05),而两组的D*和f值差异无统计学意义(P>0.05)。D值是预测MVI的独立危险因素,当其临界值为0.853×10^(-3)mm^(2)/s,预测MVI阳性的曲线下面积(AUC)、敏感度、特异度分别为0.826,80.9%和71.2%。结论:D值在预测HCC患者的MVI中优于ADC值,IVIM成像有助于HCC患者的精准治疗及术后管理。

Objective:To investigate the value of intravoxel incoherent motion imaging(IVIM) in predicting microvascular invasion(MVI) in hepatocellular carcinoma(HCC).Methods:A total of 114 patients with HCC confirmed by surgery and pathology were retrospectively included and divided into MVI-positive and MVI-negative group.All patients underwent single b-value DWI,multi-b-value IVIM and dynamic contrast enhancement before surgery.DWI-derived apparent diffusion coefficient(ADC),and IVIM-derived diffusion coefficient(D),perfusion-related diffusion coefficient(D*) and perfusion fraction(f) were measured.DWI and IVIM parameters were compared between MVI positive and negative group.Logistic regression analysis was used to determine the independent risk factors of MVI,and receiver operating characteristic(ROC) curves were used to assess diagnostic performance for positive MVI.Results:Among the 114 HCC cases,57 were MVI-positive and 47 were MVI-negative;the ADC value and D value of the MVI-positive group were lower than those of the MVI-negative group(P<0.05),while the D* and f values were not significantly different(P>0.05).D value is an independent risk factor for predicting MVI.With the cutoff of 0.853×10^(-3)mm^(2)/s,the area under the curve(AUC),sensitivity,specificity and accuracy for predicting MVI are 0.826,80.9% and 71.2%,respectively.Conclusion:D value is superior than ADC value in predicting MVI of HCC,and IVIM may be valuable for precise treatment and management of HCC patients.