West China Medical School of Sichuan University, Chengdu, 610041, Sichuan, China.
Department of Radiology, West China Hospital of Sichuan University, Guoxuexiang No. 37, Chengdu, 610041, Sichuan province, China.
Abdom Radiol (NY). 2018 Jun;43(6):1393-1403. doi: 10.1007/s00261-017-1320-3.
To validate a free-breathing dynamic contrast-enhanced-MRI (DCE-MRI) in hepatocellular carcinoma (HCC) patients using gadoxetic acid, and to determine the relationship between DCE-MRI parameters and histological results.
Thirty-four HCC patients were included in this prospective study. Free-breathing DCE-MRI data was acquired preoperatively on a 3.0 Tesla scanner. Perfusion parameters (K , K , V and the semi-quantitative parameter of initial area under the gadolinium concentration-time curve, iAUC) were calculated and compared with tumor enhancement at contrast-enhanced CT. The relationship between DCE-MRI parameters and Ki67 indices, histological grades and microvascular density (MVD) was determined by correlation analysis. Differences of perfusion parameters between different histopathological groups were compared. Receiver operation characteristic (ROC) analysis of discriminating high-grades (grade III and IV) from low-grades (grade I and II) HCC was performed for perfusion parameters.
Significant relationship was found between DCE-MRI and CT results. The DCE-MRI derived K were significantly negatively correlated with Ki-67 indices (rho = - 0.408, P = 0.017) and the histological grades (rho = - 0.444, P = 0.009) of HCC, and K and V were significantly related with tumor MVD (rho = - 0.405, P = 0.017 for K ; and rho = 0.385, P = 0.024 for V ). K , K , and iAUC demonstrated moderate diagnostic performance (iAUC = 0.78, 0.77 and 0.80, respectively) for discriminating high-grades from low-grades HCC without significant differences.
The DCE-MRI derived parameters demonstrated weak but significant correlations with tumor proliferation status, histological grades or microvascular density, respectively. This free-breathing DCE-MRI is technically feasible and offers a potential avenue toward non-invasive evaluation of HCC malignancy.
利用钆塞酸动态对比增强磁共振成像（DCE-MRI）评估肝细胞癌（HCC）患者的自由呼吸状态，同时确定 DCE-MRI 参数与组织学结果之间的关系。
本前瞻性研究共纳入 34 例 HCC 患者。术前在 3.0T 扫描仪上采集自由呼吸 DCE-MRI 数据。计算灌注参数（Ktrans、Kep、V 及半定量参数对比剂初始浓度-时间曲线下面积，iAUC），并与对比增强 CT 进行对比。采用相关性分析确定 DCE-MRI 参数与 Ki67 指数、组织学分级和微血管密度（MVD）之间的关系。比较不同组织病理学分组之间的灌注参数差异。采用受试者工作特征（ROC）分析对灌注参数进行高分级（III 级和 IV 级）和低分级（I 级和 II 级）HCC 的鉴别诊断。
DCE-MRI 与 CT 结果之间存在显著相关性。DCE-MRI 衍生的 Ktrans 与 Ki67 指数（rho = -0.408，P = 0.017）和 HCC 的组织学分级（rho = -0.444，P = 0.009）呈显著负相关，Ktrans 和 V 与肿瘤 MVD 显著相关（rho = -0.405，P = 0.017 用于 Ktrans；rho = 0.385，P = 0.024 用于 V）。Ktrans、Kep 和 iAUC 用于鉴别高分级和低分级 HCC 具有中等诊断性能（iAUC = 0.78、0.77 和 0.80），但无显著差异。
DCE-MRI 衍生参数与肿瘤增殖状态、组织学分级或微血管密度分别具有弱但显著的相关性。这种自由呼吸 DCE-MRI 技术可行，为 HCC 恶性程度的无创评估提供了一种潜在途径。
