Cao Li-Kun, Duan Ting, Chen Jie, Xia Chun-Chao, Song Bin
Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2018 Nov;49(6):914-919.
To determine the value of diffusion kurtosis imaging for predicting one-year early recurrence (ER) of hepatocellular carcinoma (HCC) after curative resection.
55 HCC patients were enrolled into this prospective study and received preoperative magnetic resonance (MR) examination including diffusion kurtosis imaging (DKI). The patients were followed up for at least one year after curative resection. The morphological features of HCC were assessed using the conventional contrast-enhanced MR images. Mean diffusivity (MD) and mean kurtosis (MK) were calculated for the intratumoral and peritumoral regions. Univariate and multivariate logistic regression analyses were performed to assess the relative value of these parameters as a potential predictor of ER. Receiver operating characteristic (ROC) curve analyses were used to determine the diagnostic performance of these quantitative parameters.
Increased alpha-fetoprotein (AFP), BCLC stage, tumor number (≥2), high grade HCC, peritumoral MK, and decreased peritumoral MD were associated with higher one-year ER of HCC (<0.05). The multivariate analyses confirmed that high grade HCC 〔odds ratio ()=5.37,95% confidence interval ():1.01-28.50,=0.048〕 and increased peritumoral MK (=5.38,95%:1.53-18.92,=0.009) were independent risk factors for the ER of HCC. The area under curve was 0.79 (<0.001) for peritumoral MK, with an optimal sensitivity of 85.2% and specificity of 64.3% at the cut-off of 0.96.
Peritumoral MK has moderate diagnostic performance in predicting ER of HCC. Higher peritumoral MK value in combination with high-grade HCC are potential biomarkers for predicting one-year ER of HCC.
确定扩散峰度成像对预测肝细胞癌（HCC）根治性切除术后1年早期复发（ER）的价值。
55例HCC患者纳入本前瞻性研究，术前行磁共振（MR）检查，包括扩散峰度成像（DKI）。患者根治性切除术后至少随访1年。利用常规对比增强MR图像评估HCC的形态学特征。计算肿瘤内及瘤周区域的平均扩散率（MD）和平均峰度（MK）。进行单因素和多因素逻辑回归分析，以评估这些参数作为ER潜在预测指标的相对价值。采用受试者工作特征（ROC）曲线分析来确定这些定量参数的诊断性能。
甲胎蛋白（AFP）升高、BCLC分期、肿瘤数目（≥2个）、高级别HCC、瘤周MK升高及瘤周MD降低与HCC 1年较高的ER相关（<0.05）。多因素分析证实，高级别HCC〔比值比（OR）=5.37，95%置信区间（CI）：1.01 - 28.50，P = 0.048〕和瘤周MK升高（OR = 5.38，95%CI：1.53 - 18.92，P = 0.009）是HCC发生ER的独立危险因素。瘤周MK的曲线下面积为0.79（P<0.001），在截断值为0.96时，最佳敏感性为85.2%，特异性为64.3%。
瘤周MK在预测HCC的ER方面具有中等诊断性能。较高的瘤周MK值与高级别HCC相结合是预测HCC 1年ER的潜在生物标志物。
