DCE-MRI定量灌注参数与原发性肝癌病理分级及预后的关系

Relationship Between DCE-MRI Quantitative Perfusion Parameters and Pathological Grading and Prognosis of Patients with Primary Liver Carcinoma

目的分析磁共振动态增强成像(DCE-MRI)定量灌注参数与原发性肝癌(PLC)患者病理分级及其预后的关系。方法回顾性分析收治的原发性肝癌106例患者的临床资料,并将其作为观察组,依据Edmondson-Steiner's肿瘤病理分级将观察组患者分为轻度组(n=32例)、中度组(n=36例)和重度组(n=38例),随访2年,依据不同预后分为存活组(n=13例)和死亡组(n=93例);选择同期收治的肝脏良性结节患者52例作为对照组。所有患者均进行DCE-MRI检查,比较其定量灌注参数对比剂从血管到组织间的渗透率(Ktrans)、血管容积分数(Vp)、血管外细胞外间隙体积百分比(Ve)、血管外细胞外间隙转运至血管内的速率常数(Kep)变化,分析其在不同病理分级和不同预后患者的差异,以及定量灌注参数对原发性肝癌病理分级的效能。结果观察组患者DCM-MRI定量参数Ktrans、Vp、Ve和Kep均较对照组高(P<0.01)。重度组患者DCM-MRI定量参数Ktrans、Vp、Ve和Kep均较轻度组和中度组高,中度组上述参数较轻度组高,差异均有统计学意义(P<0.01);Spearman相关性结果显示,DCM-MRI各定量参数Ktrans、Vp、Ve和Kep与PLC病理分级均呈正相关(γ=0.522、0.501、0.513、0.574,P<0.05)。死亡组患者DCM-MRI各定量参数Ktrans、Vp、Ve和Kep均较存活组高,差异均有统计学意义(P<0.01)。受试者工作特征曲线(ROC)分析,DCM-MRI各定量参数Ktrans、Vp、Ve和Kep指导PLC轻度与中、重度的分级及预后评估均有较高效能,四者联合诊断时效能最高,其曲线下面积分别为(area under the curve,AUC)为0.841、0.893,约登指数为0.797、0.834,敏感度、特异性分别为92.31%、93.24%与86.67%、96.70%。结论DCM-MRI定量灌注参数与原发性肝癌患者病理分级密切相关,可以依据DCM-MRI定量灌注参数对患者进行病理分级及预后评估,并指导临床治疗。

Objective To analyze the relationship between the quantitative perfusion parameters of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)and the pathological grading and prognosis of patients with primary liver carcinoma(PLC).Methods The clinical data of 106 patients with PLC admitted to the hospital were retrospectively analyzed,and the patients were selected as observation group and were divided into mild group(n=32),moderate group(n=36)and severe group(n=38)according to Edmondson-Steiner's tumor pathological grading.After 2 years of follow-up,the patients were classified into survival group(n=13)and death group(n=93)by means of different prognosis.Another 52 patients with benign liver nodules admitted to the hospital during the same period were selected as control group.All patients in the above groups underwent DCE-MRI examination.The changes in quantitative perfusion parameters of volume transfer constant(Ktrans),vascular plethysmography(Vp),extravascular-extracellular volume fraction(Ve)and rate constant(Kep)were compared,and the differences among patients with different pathological grades and prognosis status and the efficiency of quantitative perfusion parameters on the pathological grading of PLC were analyzed.Results The DCE-MRI quantitative parameters of Ktrans,Vp,Ve and Kep of patients in observation group were higher than those in the control group(P<0.01).The DCM-MRI quantitative parameters of Ktrans,Vp,Ve and Kep in severe group were higher than those in mild group and moderate group,and the above parameters in moderate group were higher than those in mild group(P<0.01).Spearman correlation results showed that DCM-MRI quantitative parameters of Ktrans,Vp,Ve and Kep were positively correlated with pathological grading of PLC(γ=0.522,0.501,0.513,0.574,P<0.05).The DCM-MRI quantitative parameters of Ktrans,Vp,Ve and Kep were higher in death group than those in survival group(P<0.01).Receiver operating characteristic curve(ROC)analysis showed that DCM-MRI quantitative parameters of Ktrans,Vp,Ve and Kep had high efficiency on guiding mild,moderate and severe PLC and evaluation of prognosis,and the efficiency of combined diagnosis of the 4 parameters was the highest,and the area under the curve(AUC),Yoden index,sensitivity and specificity were 0.841,0.797,92.31% and 93.24% or 0.893,0.834,86.67% and 96.70%,respectively.Conclusion DCE-MRI quantitative perfusion parameters are closely related to the pathological grading of patients with PLC,and can be used to evaluate the pathological grading and prognosis and guide clinical treatment of patients.