Zhao Jinkun, Li Xubin, Zhang Kun, Yin Xiaoyu, Meng Xiangfu, Han Lizhu, Zhang Xuening
Department of Radiology, The Second Hospital of Tianjin Medical University Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-hu-xi Road, Hexi District, Tianjin Department of Radiology, Linyi Traditional Chinese Medicine Hospital, Shandong, China.
Medicine (Baltimore). 2017 Aug;96(33):e7754. doi: 10.1097/MD.0000000000007754.
The aim of the study was to investigate the value of preoperative diffusion-weighted imaging (DWI) in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC), using and comparing mean and minimum apparent diffusion coefficient (ADC) values.Preoperative MR images of 318 patients with HCC confirmed by surgical pathology were retrospectively analyzed. All patients underwent preoperative DWI on a 1.5 Tesla MRI scanner. The mean and minimum ADC values of the tumors were measured. Interobserver agreements were assessed by the intraclass correlation coefficient (ICC). The ADC values were compared in HCCs between with and without MVI. ROC curves of ADC values were obtained and then compared in distinguishing HCCs with MVI from those without MVI.There were 211 HCCs with MVI and 107 HCCs without MVI. ICC for the measurements of the mean and minimum ADC values between both observers was 0.88 (95% CI 0.85 - 0.90) and 0.88 (95% CI 0.85 - 0.90), respectively. The mean and minimum ADC values of HCCs with MVI were lower than those of HCCs without MVI (P = .00, .00, respectively). With a cut-off value of 0.98 × 10 mm/s, the minimum ADC (MinADC) showed a sensitivity of 62.56% and a specificity of 65.42% in predicting MVI, whereas the mean ADC provided a sensitivity of 79.15% and a specificity of 50.47% with a cut-off value of 1.19 × 10 mm/s. No significant difference existed between MinADC and mean ADC for their diagnostic performances in the prediction of MVI (P = .48).DWI could preoperatively provide quantitative parameters for predicting MVI of HCC.
本研究旨在通过使用和比较平均表观扩散系数（ADC）值与最小表观扩散系数（ADC）值，探讨术前扩散加权成像（DWI）在预测肝细胞癌（HCC）微血管侵犯（MVI）中的价值。对318例经手术病理证实为HCC的患者的术前磁共振图像进行回顾性分析。所有患者均在1.5特斯拉磁共振成像扫描仪上进行术前DWI检查。测量肿瘤的平均ADC值和最小ADC值。通过组内相关系数（ICC）评估观察者间的一致性。比较有MVI和无MVI的HCC之间的ADC值。获得ADC值的ROC曲线，然后比较其在区分有MVI的HCC和无MVI的HCC方面的表现。有211例有MVI的HCC和107例无MVI的HCC。两位观察者之间测量平均ADC值和最小ADC值的ICC分别为0.88（95%CI 0.85 - 0.90）和0.88（95%CI 0.85 - 0.90）。有MVI的HCC的平均ADC值和最小ADC值低于无MVI的HCC（P分别为0.00、0.00）。最小ADC（MinADC）以截断值0.98×10⁻³mm²/s在预测MVI时显示出62.56%的敏感性和65.42%的特异性，而平均ADC以截断值1.19×10⁻³mm²/s时显示出79.15%的敏感性和50.47%的特异性。MinADC和平均ADC在预测MVI的诊断性能上无显著差异（P = 0.48）。DWI可以在术前提供预测HCC微血管侵犯的定量参数。
