Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
Department of Radiology, Guizhou Provincial People's Hospital, No. 83 East, Zhongshan Road, Guiyang, 550002, Guizhou, China.
BMC Cancer. 2019 Apr 18;19(1):364. doi: 10.1186/s12885-019-5574-8.
Our aim of the study is to investigate the feasibility of preoperative prediction for hepatocellular carcinoma (HCC) histological grading using gadoxetic acid-enhanced magnetic resonance imaging (MRI).
This study included one hundred and fifty-six patients with solitary HCC. Preoperative gadoxetic acid-enhanced MRI findings were retrospectively analyzed. MRI qualitative features such as tumor size, margin, capsule status, signal homogeneity, intratumoral vessels, peritumoral enhancement during mid-arterial phase, peritumoral hypointensity during the hepatobiliary phase (HBP) were investigated. Apparent diffusion coefficients (ADCs), T1 reduction ratio of pre- and post-contrast enhanced images of the tumors were calculated. HCC histological grading in surgical specimens were confirmed by Edmonson's criteria. Correlations between these MRI features and HCC histological grading were analyzed using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy of the model.
Univariate analysis showed that maximum tumor diameter (p = 0.004), tumor margin (p = 0.006), intratumoral vessels (p = 0.001) and peritumoral hypointensity during HBP (p = 0.000), were significantly correlated with HCC histological grading. There was no relationship between capsule, tumor signal, venous thrombosis, peritumoral enhancement during mid-arterial phase, ADC value, T1 reduction ratio, and HCC histological grading. Multivariate logistic regression analysis demonstrated that the maximum tumor diameter (p = 0.012, odds ratio = 1.002, 95% confidence interval: 1.007-1.046)) was an independent risk factor for high grade HCC.
Greater tumor size, a more irregular margin, presence of intratumoral vessels, and peritumoral hypointensity during HBP were indicators for high grade HCC. The maximum tumor diameter was an independent risk factor for high grade HCC.
本研究旨在探讨钆塞酸增强磁共振成像（MRI）术前预测肝细胞癌（HCC）组织学分级的可行性。
本研究纳入了 156 例单发 HCC 患者。回顾性分析了术前钆塞酸增强 MRI 表现。研究了 MRI 定性特征，如肿瘤大小、边缘、包膜状态、信号均匀性、肿瘤内血管、动脉中期肿瘤周围增强、肝胆期（HBP）肿瘤周围低信号。计算了肿瘤的表观扩散系数（ADC）、增强前后 T1 比值。手术标本中 HCC 的组织学分级采用 Edmonson 标准确认。采用多元逻辑回归分析这些 MRI 特征与 HCC 组织学分级的相关性。采用受试者工作特征（ROC）曲线评估模型的预测效能。
单因素分析显示，最大肿瘤直径（p=0.004）、肿瘤边缘（p=0.006）、肿瘤内血管（p=0.001）和 HBP 时肿瘤周围低信号（p=0.000）与 HCC 组织学分级显著相关。包膜、肿瘤信号、静脉血栓形成、动脉中期肿瘤周围增强、ADC 值、T1 降低率与 HCC 组织学分级无相关性。多因素逻辑回归分析显示，最大肿瘤直径（p=0.012，比值比=1.002，95%置信区间：1.007-1.046）是高级别 HCC 的独立危险因素。
较大的肿瘤大小、更不规则的边缘、肿瘤内血管的存在以及 HBP 时肿瘤周围低信号是高级别 HCC 的指标。最大肿瘤直径是高级别 HCC 的独立危险因素。
