Ye Zheng, Cao Likun, Wei Yi, Chen Jie, Zhang Zhen, Yao Shan, Duan Ting, Song Bin
West China School of Medicine, Sichuan University, Chengdu 610041, China.
Department of Radiology, Peking Union Medical College Hospital (Dongdan Campus), Beijing 100730, China.
Ann Transl Med. 2020 Feb;8(4):85. doi: 10.21037/atm.2020.01.04.
To prospectively determine whether the quantitative imaging parameters derived from the hepatobiliary phase (HBP) can be used for the preoperative prediction of hepatocellular carcinoma (HCC) with highly aggressive characteristics.
One hundred and three patients with surgical-proven HCC were included from July 2015 to June 2018. Two independent reviewers measured signal intensity (SI) of liver and tumor, and quantitative parameters, including relative tumor enhancement (RTE), tumor to liver contrast ratio (TLR), tumor enhancement index (TEI), and relative enhancement ratio (RER) were calculated. The aggressive characteristics of HCC were identified by using the Ki-67 labeling index (LI), and patients were classified into low aggressive (Ki-67 LI ≤10%) and high aggressive (Ki-67 LI >10%) groups. The difference of quantitative parameters between two groups was assessed, and the correlation between quantitative parameters and Ki-67 LI was explored. Receiver operating characteristic analyses was used to evaluate the predictive performance of quantitative parameters.
The values of RTE, TLR, TEI, and RER, were significantly lower in the highly aggressive group than low aggressive group (P<0.05), and negative correlations were obtained between these quantitative parameters and Ki-67 LI ( ranges from -0.41 to -0.22, P<0.05). TLR demonstrated the highest predictive performance with the area under curve (AUC) of 0.83 [95% confidence interval (CI): 0.75-0.90], sensitivity of 89.0% and specificity of 63.3%, and subsequent with RER, TEI, and RTE with AUC of 0.78 (95% CI: 0.68-0.85), 0.74 (95% CI: 0.64-0.82) and 0.68 (95% CI: 0.58-0.77), respectively. Good inter-observer and intra-observer agreement were found in all parameters.
TLR showed the highest predictive performance in highly aggressive HCC. Quantitative parameters based on HBP could preoperatively predict the aggressiveness of HCC.
前瞻性地确定源自肝胆期（HBP）的定量成像参数是否可用于术前预测具有高度侵袭性特征的肝细胞癌（HCC）。
纳入2015年7月至2018年6月期间103例经手术证实的HCC患者。两名独立的评估者测量肝脏和肿瘤的信号强度（SI），并计算包括相对肿瘤强化（RTE）、肿瘤与肝脏对比率（TLR）、肿瘤强化指数（TEI）和相对强化率（RER）在内的定量参数。通过Ki-67标记指数（LI）确定HCC的侵袭性特征，并将患者分为低侵袭性（Ki-67 LI≤10%）和高侵袭性（Ki-67 LI>10%）组。评估两组之间定量参数的差异，并探讨定量参数与Ki-67 LI之间的相关性。采用受试者工作特征分析来评估定量参数的预测性能。
高侵袭性组的RTE、TLR、TEI和RER值显著低于低侵袭性组（P<0.05），并且这些定量参数与Ki-67 LI之间存在负相关（范围从-0.41至-0.22，P<0.05）。TLR表现出最高的预测性能，曲线下面积（AUC）为0.83[95%置信区间（CI）：0.75-0.90]，灵敏度为89.0%，特异性为63.3%，随后是RER、TEI和RTE，AUC分别为0.78（95%CI：0.68-0.85）、0.74（95%CI：0.64-0.82）和0.68（95%CI：0.58-0.77）。所有参数在观察者间和观察者内均具有良好的一致性。
TLR在高度侵袭性HCC中表现出最高的预测性能。基于HBP的定量参数可在术前预测HCC的侵袭性。
