| 陆心雨,陆健,张涛,张学琴,陈培培,姜吉锋,丁丁,杜圣.钆塞酸二钠增强MRI肝胆期瘤周低信号预测肝细胞癌微血管侵犯[J].中国医学影像技术,2020,36(9):1350~1354 |
| 钆塞酸二钠增强MRI肝胆期瘤周低信号预测肝细胞癌微血管侵犯 |
| Predicting microvascular invasion of hepatocellular carcinoma according to hepatobiliary stage peritumoral hypointensity during gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI |
| 投稿时间：2019-08-14 修订日期：2020-03-07 |
| DOI：10.13929/j.issn.1003-3289.2020.09.018 |
| 中文关键词: 癌,肝细胞 微血管侵犯 对比剂 磁共振成像 |
| 英文关键词:carcinoma, hepatocellular microvascular invasion contrast media magnetic resonance imaging |
| 基金项目:江苏省研究生科研与实践创新计划（SJCX19-0867）、南通市科技计划项目（MSZ18145）。 |
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| 中文摘要: |
| 目的 观察钆塞酸二钠（Gd-EOB-DTPA）增强MRI肝胆期瘤周低信号预测肝细胞癌（HCC）微血管侵犯（MVI）的价值。方法 回顾性分析102例接受肝脏Gd-EOB-DTPA增强MRI的经病理确诊的HCC患者，根据病理结果显示是否存在MVI分为MVI阳性组及MVI阴性组。评估增强MRI肝胆期是否存在瘤周低信号及其形状，测量肿瘤最大径；比较组间瘤周低信号差异及不同大小肿瘤瘤周低信号出现率的差异，分析2组瘤周低信号形状的差异；计算肝胆期图像瘤周低信号预测HCC MVI的敏感度、特异度、准确率、阳性预测值（PPV）及阴性预测值（NPV）。结果 102例HCC中，病理显示31例存在MVI（MVI阳性组），71例不存在（MVI阴性组）。MRI示26例存在瘤周低信号；HCC最大径0.72~8.96 cm，中位数2.83 cm；其中57例≤ 3 cm，45例>3 cm。MVI阳性组20例、MVI阴性组6例存在瘤周低信号，组间肝胆期瘤周低信号出现率差异有统计学意义（χ2=35.71，P<0.01），而瘤周低信号形状差异无统计学意义（P=0.78）。4例HCC ≤ 3 cm、22例>3 cm患者存在瘤周低信号（χ2=23.21，P<0.01）。肝胆期瘤周低信号预测HCC MVI的敏感度、特异度、准确率、PPV及NPV分别为64.52%（20/31）、91.55%（65/71）、83.33%（85/102）、76.92%（20/26）及85.53%（65/76），对≤ 3 cm HCC患者分别为37.50%（3/8）、97.96%（48/49）、89.47%（51/57）、75.00%（3/4）及90.57%（48/53），>3 cm HCC患者分别为73.91%（17/23）、77.27%（17/22）、75.56%（34/45）、77.27%（17/22）及73.91%（17/23）。结论 Gd-EOB-DTPA增强MRI肝胆期瘤周低信号预测HCC发生MVI特异度较高，对≤ 3 cm HCC尤高。 |
| 英文摘要: |
| Objective To investigate the value of hepatobiliary stage peritumoral hypointensity during gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MR scanning for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Methods Data of 102 patients with HCC confirmed by pathology who received Gd-EOB-DTPA enhanced MRI were retrospectively analyzed. The patients were divided into MVI positive group and MVI negative group according to pathological findings. Then the presence or absence of hepatobiliary stage peritumoral hypointensity on enhanced MRI were evaluated, the shapes of MVI were depicted, and the sizes of HCC lesions were measured on MRI. The rates of peritumoral hypointensity were compared between groups and between different sized tumors, and the difference of peritumoral hypointensity shapes were analyzed and compared between groups. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for peritumoral hypointensity in predicting MVI of HCC were calculated. Results Among 102 patients, 31 were found with MVI (MVI positive group) while 71 were not (MVI negative group) with pathological examinations. MRI showed peritumoral hypointensity in 26 patients, with 0.72-8.96 cm HCC (the median size 2.83 cm). Among 102 patients, HCC ≤ 3 cm was detected in 57 cases, >3 cm in 45 cases. Peritumoral hypointensity was observed in 20 patients in MVI positive group and 6 patients in MVI negative group (χ2=35.71, P<0.01), while no significant difference of the shapes of peritumoral hypointensity was found between 2 groups (P=0.78). Among patients with peritumoral hypointensity, 4 were found with HCC ≤ 3 cm and 22 with HCC >3 cm (χ2=23.21, P<0.01). The sensitivity, specificity, accuracy, PPV and NPV of peritumoral hypointensity for predicting MVI of HCC patients was 64.52% (20/31), 91.55% (65/71), 83.33% (85/102), 76.92% (20/26) and 85.53% (65/76), respectively, for patients with HCC ≤ 3 cm was 37.50% (3/8), 97.96% (48/49), 89.47% (51/57), 75.00% (3/4) and 90.57% (48/53), respectively, and for those with HCC >3 cm was 73.91% (17/23), 77.27% (17/22), 75.56% (34/45), 77.27% (17/22) and 73.91% (17/23), respectively. Conclusion Hepatobiliary stage peritumoral hypointensity during Gd-EOB-DTPA enhanced MRI had high specificity for predicting MVI of HCC, especially for patients with ≤ 3 cm HCC. |
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