Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China; Department of Radiology, First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian, 116011, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Eur J Radiol. 2019 Aug;117:164-170. doi: 10.1016/j.ejrad.2019.06.016. Epub 2019 Jun 18.
To investigate potential findings associated with cytokeratin 19 (CK19)-positive HCC, with special emphasis on MR texture analysis.
Forty-eight patients with CK19-negative HCC and 38 patients with CK19-positive were retrospectively evaluated by texture analysis based on conventional MRI. Clinicalpathological characteristics, conventional MR imaging findings, and the MR texture analysis contained of 2415 texture features in the seven conventional sequences were compared. Significant features for differentiating were identified by univariate and multivariate analyses. Receiver operating characteristic analyses of the significant findings were performed and compared to evaluate their diagnostic performance.
There was no significant difference between the top1 texture feature (three-dimensional standard deviation separation of intensity on T2-weighted original images, abbreviated as: StdSeparation 3D) and the combined top1-6 feature in identifying CK19-positive HCC(P = 0.660). Univariate and multivariate analyses indicated that serum alpha-fetoprotein (AFP) level ≥400 ng/mL(P = 0.013), arterial rim enhancement(P = 0.005), and StdSeparation 3D texture character(P = 0.002) were independent variables associated with CK19-positive HCCs. The combination of the three indices showed a better performance than AFP level(P = 0.0028), arterial rim enhancement(P < 0.0001), and their combination(P = 0.0098); while no significantly better than the StdSeparation 3D texture character alone(P = 0.0788). An acceptable discrimination(AUC = 0.765) with both sensitivity and specificity greater than 75% was achieved for StdSeparation 3D texture character.
Serum AFP level ≥400 ng/mL, arterial rim enhancement, and the StdSeparation 3D texture character were independently associated with CK19-positive HCC. The StdSeparation 3D texture character may be a reliable imaging biomarker which can improve the diagnostic performance.
探讨与细胞角蛋白 19（CK19）阳性 HCC 相关的潜在发现，特别强调磁共振纹理分析。
回顾性分析了 48 例 CK19 阴性 HCC 患者和 38 例 CK19 阳性 HCC 患者的常规 MRI 纹理分析资料。比较了临床病理特征、常规 MR 成像结果以及 7 个常规序列中包含的 2415 个纹理特征的 MR 纹理分析。通过单变量和多变量分析确定有显著差异的特征。对有显著差异的特征进行接收者操作特征分析，并进行比较以评估其诊断性能。
在识别 CK19 阳性 HCC 方面，top1 纹理特征（三维 T2 加权原始图像强度标准差分离，简称：StdSeparation 3D）和 top1-6 特征组合之间没有显著差异（P=0.660）。单变量和多变量分析表明，血清甲胎蛋白（AFP）水平≥400ng/mL（P=0.013）、动脉边缘增强（P=0.005）和 StdSeparation 3D 纹理特征（P=0.002）是与 CK19 阳性 HCC 相关的独立变量。这三个指标的组合表现优于 AFP 水平（P=0.0028）、动脉边缘增强（P<0.0001）及其组合（P=0.0098），但与 StdSeparation 3D 纹理特征本身相比（P=0.0788）无显著差异。单独使用 StdSeparation 3D 纹理特征可获得较好的鉴别能力（AUC=0.765），其灵敏度和特异性均大于 75%。
血清 AFP 水平≥400ng/mL、动脉边缘增强和 StdSeparation 3D 纹理特征与 CK19 阳性 HCC 独立相关。StdSeparation 3D 纹理特征可能是一种可靠的成像生物标志物，可提高诊断性能。
