Hu M J, Yu Y X, Fan Y F, Jiang Y M, Hu S, Wang X M, Hu C H
Department of Radiology, the First Affiliated Hospital of Soochow University, Institute of Medical Imaging of Soochow University, Suzhou 215006, China.
Department of General Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Zhonghua Yi Xue Za Zhi. 2020 May 5;100(17):1299-1304. doi: 10.3760/cma.j.cn112137-20191021-02281.
To investigate the predictive value of gadolinium-ethoxybenzyl- diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI imaging features combined with quantitative parameters for the pathologic grading of hepatocellular carcinoma (HCC). Eighty patients (65 males, 15 females; range 30-74 years,average age (59±11) years old) with HCC who underwent curative resection or biopsy from June 2016 to June 2019 in the First Affiliated Hospital of Soochow University after Gd-EOB-DTPA-enhanced MRI were evaluated retrospectively.According to the pathological results of the postoperative pathology, eighty patients were divided into poorly differentiated group (26 cases, 22 males, 4 females) and moderately-well differentiated group (54 cases, 43 males, 11 females). In Gd-EOB-DTPA-enhanced MRI, qualitative parameters were assessed. Quantitative parameters including tumor size, tumor-to-liver signal intensity ratio(SIR) of arterial phase (AP), portal vein phase (PP), equilibrium phase (EP) and hepatobiliary phase (HBP), contrast enhancement ration AP (CER-AP)were measured and calculated. Clinical data and qualitative parameters between poorly differentiated group and moderately-well differentiated group were analyzed by using χ(2) test.Quantitative parameters were analyzed by using independent sample test. Statistically significant qualitative parameters, quantitative parameters, qualitative combined with quantitative parameters and AFP combined with qualitative and quantitative parameters were included in binary logistic regression model. The receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of the four prediction model for the pathologic grading of HCC. There was a statistical difference between poorly differentiated group and moderately-well differentiated group in AFP, arterial peritumoral enhancement, arterial rim enhancement, peritumoral hypointensity on HBP and tumor signal (all 0.05). In two groups, tumor size, SIR-AP and SIR-PP were (7.0±3.7) vs (3.9±2.4)cm,1.11±0.29 vs 1.31±0.32 and 0.89±0.21 vs 1.03±0.27 (all 0.05). AUC of qualitative parameters, quantitative parameters, qualitative combined with quantitative parameters and AFP combined with qualitative and quantitative parameters were 0.805, 0.804, 0.855, 0.892.There was a statistical difference between qualitative parameters and qualitative combined with quantitative parameters in sensitivity(80.8% vs 92.3%, 0.05). Gd-EOB-DTPA-enhanced MRI imaging features combined with quantitative parameters can be used to predict the pathologic grading of HCC preoperatively, which has a great applicative value.
探讨钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）特征联合定量参数对肝细胞癌（HCC）病理分级的预测价值。回顾性分析2016年6月至2019年6月在苏州大学附属第一医院接受Gd-EOB-DTPA增强MRI检查后行根治性切除或活检的80例HCC患者（男65例，女15例；年龄30 - 74岁，平均年龄（59±11）岁）。根据术后病理结果，将80例患者分为低分化组（26例，男22例，女4例）和中高分化组（54例，男43例，女11例）。在Gd-EOB-DTPA增强MRI中评估定性参数。测量并计算包括肿瘤大小、动脉期（AP）、门静脉期（PP）、平衡期（EP）和肝胆期（HBP）的肿瘤与肝脏信号强度比（SIR）、AP期对比增强率（CER-AP）等定量参数。采用χ(2)检验分析低分化组和中高分化组之间的临床资料和定性参数。采用独立样本检验分析定量参数。将具有统计学意义的定性参数、定量参数、定性联合定量参数以及甲胎蛋白（AFP）联合定性和定量参数纳入二元逻辑回归模型。采用受试者操作特征（ROC）曲线评估四种预测模型对HCC病理分级的诊断效能。低分化组和中高分化组在AFP、动脉期瘤周强化、动脉边缘强化、HBP期瘤周低信号和肿瘤信号方面存在统计学差异（均P<0.05）。两组间肿瘤大小、SIR-AP和SIR-PP分别为（7.0±3.7）cm vs（3.9±2.4）cm、1.11±0.29 vs 1.31±0.32和0.89±0.21 vs 1.03±0.27（均P<0.05）。定性参数、定量参数、定性联合定量参数以及AFP联合定性和定量参数的曲线下面积（AUC）分别为0.805、0.804、0.855、0.892。定性参数与定性联合定量参数在敏感度方面存在统计学差异（80.8% vs 92.3%，P<0.05）。Gd-EOB-DTPA增强MRI特征联合定量参数可用于术前预测HCC的病理分级，具有较大的应用价值。
