Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, People's Republic of China.
Philips Intergrated Solution Center, Guangzhou, People's Republic of China.
Eur Radiol. 2019 Nov;29(11):5791-5803. doi: 10.1007/s00330-019-06180-1. Epub 2019 Apr 10.
To determine the diagnostic performance of intravoxel incoherent motion (IVIM) parameters to predict tumor recurrence after hepatectomy in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).
One hundred and fifty-seven patients (mean age 52.54 ± 11.32 years, 87% male) with surgically and pathologically confirmed HCC were included. Regions of interests were drawn including the tumors by two independent radiologists. ADC and IVIM-derived parameters (true diffusion coefficient [D]; pseudodiffusion coefficient [D*]; pseudodiffusion fraction [f]) were obtained preoperatively. The Cox proportional hazards model was used to analyze the predictors associated with tumor recurrence after hepatectomy.
Forty-seven of 157 (29.9%) patients experienced tumor recurrence. The multivariate Cox proportional hazards model revealed that a D value < 0.985 × 10 mm/s (hazard ratio (HR), 0.190; p = 0.023) was a risk factor for tumor recurrence. Additional risk factors included younger age (HR, 0.328; p = 0.034) and higher serum alpha-fetoprotein (AFP) level (HR, 2.079; p = 0.013). Further, receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of the obtained Cox regression model improved from 0.68 for the combination of AFP and age alone to 0.724 for the combination of D value, AFP, and age.
The D value derived from the IVIM model is a potential biomarker for the preoperative prediction of recurrence after hepatectomy in patients with HCC. When combined with age and AFP levels, D can improve the predictive performance for tumor recurrence.
• The recurrence rate of HCC after hepatectomy was higher in patients with ADC, D, and f values that were lower than the optimal cutoff values. • The optimal cutoff values of ADC, D, D*, and f for predicting recurrence in HBV associated HCC were 0.858 × 10 mm/s, 0.985 × 10 mm/s, 12.5 × 10 mm/s, and 23.4%, respectively. • The D value derived from IVIM diffusion-weighted imaging may be a useful biomarker for preoperative prediction of recurrence after hepatectomy in patients with HCC. When combined with age and AFP levels, D can improve the predictive performance for tumor recurrence.
确定体素内不相干运动（IVIM）参数在预测乙型肝炎病毒（HBV）相关肝细胞癌（HCC）患者肝切除术后肿瘤复发中的诊断性能。
共纳入 157 例经手术和病理证实的 HCC 患者（平均年龄 52.54±11.32 岁，87%为男性）。由两名独立的放射科医生在术前通过感兴趣区域（ROI）对肿瘤进行勾画。获得 ADC 和 IVIM 衍生参数（真实扩散系数[D]；假性扩散系数[D*]；假性扩散分数[f]）。采用Cox 比例风险模型分析与肝切除术后肿瘤复发相关的预测因素。
157 例患者中 47 例（29.9%）发生肿瘤复发。多变量 Cox 比例风险模型显示，D 值<0.985×10 mm/s（风险比（HR），0.190；p=0.023）是肿瘤复发的危险因素。其他危险因素包括年龄较小（HR，0.328；p=0.034）和血清甲胎蛋白（AFP）水平较高（HR，2.079；p=0.013）。进一步的受试者工作特征（ROC）分析显示，基于 Cox 回归模型的曲线下面积（AUC）从 AFP 和年龄联合的 0.68 提高到 D 值、AFP 和年龄联合的 0.724。
IVIM 模型获得的 D 值是预测 HCC 患者肝切除术后复发的潜在生物标志物。当与年龄和 AFP 水平相结合时，D 可以提高肿瘤复发的预测性能。
与 ADC、D 和 f 值低于最佳截断值的患者相比，HCC 患者肝切除术后 HCC 的复发率更高。
预测 HBV 相关 HCC 复发的 ADC、D、D*和 f 的最佳截断值分别为 0.858×10 mm/s、0.985×10 mm/s、12.5×10 mm/s 和 23.4%。
来自 IVIM 扩散加权成像的 D 值可能是预测 HCC 患者肝切除术后复发的有用生物标志物。当与年龄和 AFP 水平相结合时，D 可以提高肿瘤复发的预测性能。
