用锝-99m 标记的聚合白蛋白测定肝细胞癌患者肺分流分数的指标
Indicators of Lung Shunt Fraction Determined by Technetium-99 m Macroaggregated Albumin in Patients with Hepatocellular Carcinoma.
作者信息
Kallini Joseph Ralph, Gabr Ahmed, Hickey Ryan, Kulik Laura, Desai Kush, Yang Yihe, Gates Vanessa L, Riaz Ahsun, Salem Riad, Lewandowski Robert J
机构信息
Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair Street, Suite 800, Chicago, IL, USA.
Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, 60611, USA.
出版信息
Cardiovasc Intervent Radiol. 2017 Aug;40(8):1213-1222. doi: 10.1007/s00270-017-1619-z. Epub 2017 Mar 9.
PURPOSE
To determine the correlation of pre-procedural and imaging characteristics with lung shunt fraction (LSF) measured by technetium-99 m macroaggregated albumin (Tc-MAA) scan in patients with hepatocellular carcinoma.
METHODS
A retrospective study was conducted of 428 subjects with hepatocellular carcinoma from 2004 to 2011 assessed for lung shunting by Tc-MAA scan. Baseline characteristics included age, gender, ethnicity, tumor burden, maximum dimension, number of lesions, presence of extrahepatic metastases, macrovascular (hepatic and portal vein) invasion, ascites on imaging, laboratory values, and alpha-fetoprotein (AFP). Univariate and multivariate logistic regression analysis was performed. Receiver operating characteristic curves were used to obtain sensitivity (SN), specificity (SP), and positive likelihood ratios (LR) of characteristics for low LSF (LSF <10%) and high LSF (LSF >20%).
RESULTS
Statistically significant (p < 0.05) independent indicators of low LSF included bilirubin <1.45 mg/dL (SN = 49.5%, SP = 69.1%, LR = 1.60), maximum tumor size <7.15 cm (SN = 66.0%, SP = 75.9%, LR = 2.74), AFP ≤200 ng/mL (SN = 64.6%, SP = 65.0%, LR = 1.85), and absent macrovascular invasion (SN = 73.9%, SP = 64.9%, LR = 2.11). Independent indicators of high LSF included albumin <2.65 g/dL (SN = 64.3%, SP = 64.1%, LR = 1.79) and macrovascular invasion (SN = 74.4%, SP = 67.4%, LR = 2.28). A combined risk factor model was constructed. If there is no macrovascular invasion: [Formula: see text]. With macrovascular invasion, [Formula: see text] (R = 0.257). Since these factors all have LR between 2 and 5, they only reflect slight increase in LSF predictivity.
CONCLUSION
Serum AFP, albumin, bilirubin, and portal/hepatic vein invasion on cross-sectional imaging are statistically significant but weak clinical indicators of LSF, as shown by low SN, SP, and LR for clinically relevant cutoff LSF values. Thus, these factors cannot be relied upon in clinical practice.
目的
确定肝细胞癌患者术前及影像学特征与通过锝-99m 聚合白蛋白（Tc-MAA）扫描测量的肺分流分数（LSF）之间的相关性。
方法
对 2004 年至 2011 年期间 428 例接受 Tc-MAA 扫描评估肺分流情况的肝细胞癌患者进行回顾性研究。基线特征包括年龄、性别、种族、肿瘤负荷、最大直径、病灶数量、肝外转移情况、大血管（肝静脉和门静脉）侵犯情况、影像学检查显示的腹水情况、实验室检查值以及甲胎蛋白（AFP）。进行单因素和多因素逻辑回归分析。采用受试者工作特征曲线来获取低 LSF（LSF <10%）和高 LSF（LSF >20%）特征的敏感性（SN）、特异性（SP）和阳性似然比（LR）。
结果
低 LSF 的具有统计学意义（p <0.05）的独立指标包括胆红素<1.45 mg/dL（SN = 49.5%，SP = 69.1%，LR = 1.60）、最大肿瘤大小<7.15 cm（SN = 66.0%，SP = 75.9%，LR = 2.74）、AFP≤200 ng/mL（SN = 64.6%，SP = 65.0%，LR = 1.85）以及无大血管侵犯（SN = 73.9%，SP = 64.9%，LR = 2.11）。高 LSF 的独立指标包括白蛋白<2.65 g/dL（SN = 64.3%，SP = 64.1%，LR = 1.79）和大血管侵犯（SN = 74.4%，SP = 67.4%，LR = 2.28）。构建了一个综合风险因素模型。如果没有大血管侵犯：[公式：见原文]。有大血管侵犯时，[公式：见原文]（R = 0.257）。由于这些因素的 LR 均在 2 至 5 之间，它们仅反映 LSF 预测性的轻微增加。
结论
血清 AFP、白蛋白、胆红素以及横断面影像学检查显示的门静脉/肝静脉侵犯在统计学上具有意义，但作为 LSF 的临床指标较弱，这表现为对于临床相关的 LSF 临界值，SN、SP 和 LR 较低。因此，在临床实践中不能依赖这些因素。
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