基于钆塞酸二钠增强MRI预测肝细胞癌微血管侵犯及术后早期复发

Prediction of Microvascular Invasion in Hepatocellular Carcinoma and Early HCC Recurrence Based on Gd-EOB-DTPA-Enhanced MRI

目的本研究主要基于钆塞酸二钠增强MRI预测肝细胞癌(Hepatocellular carcinoma,HCC)微血管侵犯(Microvascular Invasion,MVI)及HCC术后早期复发(early HCC recurrence,EHR)。方法本研究回顾性收集158例本院行肝切除术的HCC患者,所有患者术前2周内行钆塞酸二钠增强MRI检查,术前临床资料及术后病理资料完整,所有病灶均进行MVI评估,应用Logistics回归分析确认MVI的危险因素;对所有病灶进行定期随诊,患者两年内发生复发或转移定义为早期复发,应用Cox回归分析确认EHR的危险因素。应用受试者工作曲线(ROC)计算预测MVI及EHR的曲线下面积(AUC)。结果共纳入158例患者,男性83例,女性75例,平均年龄59岁(35-83岁),其中MVI阳性HCC共55例,MVI阴性HCC共103例,多因素Logistics回归分析得出肿瘤T2WI信号不均匀(OR:5.205,95%CI:2.346-11.549)及肝胆期瘤周低信号(OR:2.900,95%CI:1.278-6.577)是预测MVI阳性的危险因素,预测MVI的AUC为0.738(95%CI:0.662-0.805),敏感性74.55%(95%CI:0.610-0.853),特异性63.73%(95%CI:0.536-0.730)。所有患者定期随访发现早期复发组共67例(42.41%),其中MVI阳性组中早期复发共40例(72.73%),MVI阴性组中早期复发共27例(26.21%);多因素Cox回归分析得出MVI阳性(OR:3.070,95%CI:1.711-5.510)、肿瘤T 2 W I信号不均匀(O R:2.451,95%C I:1.292-4.650)以及异常凝血酶原(OR:1.000,95%CI:1.0002-1.001)是预测EHR的危险因素。预测EHR的AUC为0.76(95%CI:0.686-0.825),敏感性59.09%(95%CI:0.463-0.710),特异性85.71%(95%CI:0.768-0.922)。结论基于钆塞酸二钠增强MRI能够预测HCC MVI阳性,肿瘤T2WI信号不均匀及肝胆期瘤周低信号预测MVI阳性的危险因素;MVI联合临床及影像特征能够预测HCC术后早期复发,MVI阳性、肿瘤T2WI信号不均匀以及高异常凝血酶原是预测EHR的危险因素。

Objective The main purpose of this study is to predict Microvascular Invasion(MVI)of Hepatocellular carcinoma(HCC)and early HCC recurrence(EHR)after HCC surgery based on gadolinium disodium enhanced MRI.Methods In this study,158 patients who underwent hepatectomy in our hospital were retrospectively collected.All patients underwent Gd-EOB-DTPA-enhanced MRIexamination within 2 weeks before surgery.The preoperative clinical data and postoperative pathological data were complete,and all lesions were evaluated by MVI.Logistics regression analysis was used to identify the risk factors of MVI.All lesions were followed up regularly.Recurrence or metastasis within 2 years was defined as early recurrence,and Cox regression analysis was used to identify risk factors for EHR.Receiver operating Characteristic curve(ROC)was used to calculate the area under curve(AUC)of MVI and EHR.Results A total of 158 patients,83 males and 75 females,with an average age of 59 years(35-83 years),were enrolled,including 55 MVI positive HCC patients and 103 MVI negative HCC patients.Multivariate logistic regression analysis showed that tumour signal nonuniform on T2WI(OR:5.205,95%CI:2.346-11.549)and peritumoural hypointensity on the Hepatobiliary phase(OR:2.900,95%CI:1.278-6.577)were risk factors for predicting MVI.The predictive AUC of MVI was 0.738(95%CI:0.662-0.805),the sensitivity was 74.55%(95%CI:0.610-0.853),and the specificity was 63.73%(95%CI:0.536-0.730).A total of 67 patients(42.41%)were found in the early recurrence group during follow-up,including 40(72.73%)in the MVI positive group and 27(26.21%)in the MVI negative group.Multivariate Cox regression analysis showed positive MVI(OR:3.070,95%CI:1.711-5.510),umour signal nonuniform on T2WI(OR:2.451,95%CI:1.292-4.650)and PIVKA-II(OR:1.000,95%CI:1.0002-1.001)were risk factors for predicting EHR.The predictive AUC of EHR was 0.76(95%CI:0.686-0.825),the sensitivity was 59.09%(95%CI:0.463-0.710),and the specificity was 85.71%(95%CI:0.768-0.922).Conclusions Gadolinium disodium enhanced MRI can predict the risk factors of positive MVI for HCC,tumour signal nonuniform on T2WI and peritumoural hypointensity on the Hepatobiliary phase are risk factors for predicting.MVI combined with clinical and imaging features can predict early recurrence of HCC,and MVI positive,tumour signal nonuniform on T2WI and PIVKA-II are risk factors for predicting EHR.