磁共振成像增强序列肝胆特异期形态学征象及定量参数预测肝癌术后复发的价值

The value of MRI-enhanced sequence hepatobiliary-specific phase morphology and quantitative parameters in predicting postoperative recurrence of hepatocellular carcinoma

目的分析肝细胞肝癌(HCC)术后复发预测中磁共振成像(MRI)增强序列肝胆特异期形态学征象及定量参数的应用价值。方法选取2020年9月至2023年9月收治的76例HCC患者,入组者均行MRI检查,分析MRI增强扫描预测肝癌术后复发的价值。结果76例患者随访术后复发25例,无复发51例,患者肝胆特异期呈低信号74例(97%),呈等或高信号2例(3%);肿瘤边界规则46例(39%),不规则30例(61%);瘤旁低信号12例(16%),其余64例(84%)未观察到瘤旁低信号;高等级组增强后肿瘤/肝实质对比度(RIR)、肿瘤对比强化率(CER)水平较低等级组更低(P<0.05);复发组增强后RIR、CER水平较未复发组更低(P<0.05);肿瘤边界规则组复发率9%(4/46)较肿瘤边界不规则组30%(9/30)更低(P<0.05);高CER组复发率7%(3/42)较低,CER组29%(10/34)更低(P<0.05);多因素Cox回归分析显示,CER、肿瘤边界不规则是肝癌术后复发的独立危险因素(P<0.05)。结论肝癌术后复发预测中MRI增强序列肝胆特异期形态学征象及定量参数有着较高应用价值,可指导临床诊治。

Objective To analyze the value of morphological signs and quantitative parameters in the hepatobiliary-specific phase of MRI-enhanced sequences in the prediction of postoperative recurrence of hepatocellular carcinoma(HCC).Methods Seventy-six HCC patients admitted from September 2020 to September 2023 were selected,and all enrolled patients underwent MRI examination to analyze the value of MRI enhancement scanning in predicting postoperative recurrence of hepatocellular carcinoma.Results Twenty-five cases of 76 patients had postoperative recurrence and 51 cases had no recurrence in the follow-up.Seventy-four cases(97%)of the patients showed low signal in hepatobiliary specific phase,and 2 cases(3%)showed equal or high signal;46 cases(39%)had regular tumor boundaries,and 30 cases(61%)had irregular ones;12 cases(16%)had paraneoplastic low signal,and the remaining 64 cases(84%)were not observed paraneoplastic low signal;The enhanced RIR and CER levels were lower in the high-grade group than in the low-grade group(P<0.05).The enhanced RIR and CER levels were lower in the recurrent group than in the non-recurrent group(P<0.05).The recurrence rate of 9%(4/46)in the group with regular tumor borders was lower than that of 30%(9/30)in the group with irregular tumor borders(P<0.05);and the recurrence rate of 7%(3/42)in the high-CER group was lower than that of 29%(10/34)in the low-CER group(P<0.05).Multifactorial Cox regression analysis showed that CER and tumor border irregularity were independent risk factors for postoperative recurrence of hepatocellular carcinoma(P<0.05).Conclusion The morphological signs and quantitative parameters of hepatobiliary specific phase of MRI enhancement sequences in the prediction of postoperative recurrence of hepatocellular carcinoma have high application value and can guide clinical diagnosis and treatment.