基于钆塞酸二钠增强磁共振成像预测肝细胞癌切除术后早期复发的初步研究
Prediction of early recurrence of hepatocellular carcinoma after resection based on Gd-EOB-DTPA enhanced magnetic resonance imaging: a preliminary study.
作者信息
Zhao Qi-Yu, Liu Shi-Shun, Fan Ming-Xin
机构信息
Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Medical Imaging Department, Jinan Second People's Hospital, Jinan, China.
出版信息
J Gastrointest Oncol. 2022 Apr;13(2):792-801. doi: 10.21037/jgo-22-224.
BACKGROUND
Early recurrence (ER) after radical resection of hepatocellular carcinoma (HCC) affects the prognosis of patients. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) can improve the detection rate of small HCC. This study innovatively introduces a new quantitative index combined with qualitative index to compare the differences in clinical and imaging characteristics between ER and non-ER groups and evaluate the feasibility of Gd-EOB-DTPA-enhanced MRI in predicting ER.
METHODS
A total of 68 patients with HCC confirmed by operation and pathology in the Shandong Cancer Hospital and Institute were included retrospectively. All participants were examined by Gd-EOB-DTPA-enhanced MRI within 3 weeks before surgery. Regular follow-up was performed every 2 months within 1 year after operation. Among them, 18 cases with new lesions were in ER group, and 50 cases without new lesions were in non-ER group. The clinical and imaging data of the 2 groups were collected, and the differences of clinical data and preoperative MRI signs between the ER group and non-ER group were compared. The predictive factors of ER after HCC were analyzed by multivariate logistic regression.
RESULTS
The quantitative parameter lesion-to-liver contrast enhancement ratio (LLCER) can predict the pathological grade of HCC (P=0.023). The results of univariate analysis between the ER group and non-ER group showed that there were significant differences in pathological grade (P=0.008), lesion morphology (P=0.011), peritumoral low signal intensity in hepatobiliary phase (HBP) (P<0.001), satellite nodules (P<0.001), and LLCER (P<0.001) between the 2 groups. Multivariate logistic regression analysis showed that HBP peritumoral low signal intensity [odds ratio (OR) =7.214, 95% confidence interval (CI): 1.230-42.312, P=0.029], satellite nodules (OR =9.198, 95% CI: 1.402-60.339, P=0.021), and parameter LLCER value (OR =0.906, 95% CI: 0.826-0.995, P=0.039) were independent predictors of ER of HCC after resection.
CONCLUSIONS
Preoperative Gd-EOB-DTPA enhanced MRI has important predictive value for early recurrence after radical resection of hepatocellular carcinoma.
背景
肝细胞癌（HCC）根治性切除术后的早期复发（ER）影响患者预后。钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）可提高小肝癌的检出率。本研究创新性地引入新的定量指标并结合定性指标，比较ER组与非ER组的临床及影像特征差异，评估Gd-EOB-DTPA增强MRI预测ER的可行性。
方法
回顾性纳入山东省肿瘤防治研究院经手术及病理确诊的68例HCC患者。所有受试者均在术前3周内行Gd-EOB-DTPA增强MRI检查。术后1年内每2个月进行定期随访。其中，有新发病灶的18例为ER组，无新发病灶的50例为非ER组。收集两组的临床及影像资料，比较ER组与非ER组临床资料及术前MRI征象的差异。采用多因素logistic回归分析HCC术后ER的预测因素。
结果
定量参数病灶-肝脏对比增强率（LLCER）可预测HCC的病理分级（P=0.023）。ER组与非ER组单因素分析结果显示，两组间病理分级（P=0.008）、病灶形态（P=0.011）、肝胆期（HBP）瘤周低信号（P<0.001）、卫星结节（P<0.001）及LLCER（P<0.001）差异有统计学意义。多因素logistic回归分析显示，HBP瘤周低信号[比值比（OR）=7.214，95%置信区间（CI）：1.230-42.312，P=0.029]、卫星结节（OR =9.198，95%CI：1.402-60.339，P=0.021）及参数LLCER值（OR =0.906，95%CI：0.826-0.995，P=0.039）是HCC切除术后ER的独立预测因素。
结论
术前Gd-EOB-DTPA增强MRI对肝细胞癌根治性切除术后早期复发具有重要的预测价值。
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