T1映射联合钆塞酸二钠增强磁共振成像预测肝细胞癌的病理分级

T1 mapping combined with Gd-EOB-DTPA-enhanced magnetic resonance imaging in predicting the pathologic grading of hepatocellular carcinoma.

作者信息

Chen C Y, Chen J, Xia C C, Huang Z X, Song B

机构信息

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

出版信息

J Biol Regul Homeost Agents. 2017 Oct-Dec;31(4):1029-1036.

DOI:
Abstract

The aim of this study was to investigate the value of Gd-EOB-DTPA-enhanced MRI on hepatobiliary phase (HBP) imaging and T1 mapping sequence in the differentiation of hepatocellular carcinoma (HCC). A total of 45 patients with HCC who were to undergo a resection were enrolled in this study. Gd-EOB-DTPA-enhanced magnetic resonance examination was performed prior to resection. T1 mapping was performed before and 20 min after injection of Gd-EOB-DTPA. T1 values of the lesions were measured on pre-contrast (T1p) and during HBP (T1-HBP) on T1 maps. The signal intensity, the diameter and the margin of HCC lesions on HBP images were analyzed. The reduction in T1 value (T1d) and the reduction rate (ΔT1%) of T1 mapping between pre-contrast and HBP were calculated. The Edmondson-Steiner classification of each lesion was made after surgery. The SPSS software package was used for statistical analysis and the analysis of receiver operator characteristic (ROC) curve and area under the curve (AUC) were carried out by using MedCalc software package. Mean values of T1p and T1-HBP were 1935.4±730.8 ms and 1257.1±529.1 ms, respectively. T1p accuracy (AUC = 0.685, p = 0.037) in predicting pathological grading was similar to that of T1-HBP (AUC = 0.751, p = 0.005). A T1p of 1648.2 ms or greater had a sensitivity and specificity of 85.19% and 61.11%, respectively. A T1-HBP of 1006 ms or greater had a sensitivity and specificity of 81.84% and 61.11%, respectively. The number of HCCs with a non-smooth tumor margin was 20 (44.4%), and a non-smooth tumor margin correlated moderately with the Edmondson-Steiner grade (Spearman r = 0.491, p = 0.041). There was no significant correlation between T1d, ΔT1%, HCC signal intensity on HBP image and lesion diameter with pathologic grading. T1 mapping in pre-contrast and HBP of Gd-EOB-DTPA-enhanced MRI, a non-smooth tumor margin in the HBP of Gd-EOB-DTPA-enhanced MRI, are useful in predicting the pathologic grading of HCC.

摘要

本研究旨在探讨钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)在肝胆期(HBP)成像及T1mapping序列对肝细胞癌(HCC)的鉴别诊断价值。本研究共纳入45例拟行手术切除的HCC患者。术前进行Gd-EOB-DTPA增强磁共振检查。在注射Gd-EOB-DTPA前及注射后20分钟进行T1mapping。在T1图上测量病变在对比剂前(T1p)及HBP期(T1-HBP)的T1值。分析HBP图像上HCC病变的信号强度、直径及边界。计算对比剂前与HBP期T1mapping的T1值降低量(T1d)及降低率(ΔT1%)。术后对每个病变进行Edmondson-Steiner分级。采用SPSS软件包进行统计分析,使用MedCalc软件包进行受试者操作特征(ROC)曲线及曲线下面积(AUC)分析。T1p和T1-HBP的平均值分别为1935.4±730.8ms和1257.1±529.1ms。T1p预测病理分级的准确性(AUC = 0.685,p = 0.037)与T1-HBP(AUC = 0.751,p = 0.005)相似。T1p≥1648.2ms时,敏感度和特异度分别为85.19%和61.11%。T1-HBP≥1006ms时,敏感度和特异度分别为81.84%和61.11%。肿瘤边界不光滑的HCC有20例(44.4%),肿瘤边界不光滑与Edmondson-Steiner分级呈中度相关(Spearman r = 0.491,p = 0.041)。T1d、ΔT1%、HBP图像上HCC信号强度及病变直径与病理分级之间无显著相关性。Gd-EOB-DTPA增强MRI对比剂前及HBP期的T1mapping、Gd-EOB-DTPA增强MRI的HBP期肿瘤边界不光滑,对预测HCC的病理分级有一定价值。

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