Wang Fei, Yan Chun Yue, Wang Cai Hong, Yang Yan, Zhang Dong
Department of Medical Imaging, Luzhou People's Hospital, Luzhou, China.
Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Front Oncol. 2022 May 11;12:884854. doi: 10.3389/fonc.2022.884854. eCollection 2022.
Currently, there are disputes about the parameters of diffusion kurtosis imaging (DKI), intravoxel incoherent motion (IVIM), and diffusion-weighted imaging (DWI) in predicting pathological grades and microvascular invasion (MVI) in hepatocellular carcinoma (HCC). The aim of our study was to investigate and compare the predictive power of DKI and IVIM-DWI parameters for preoperative evaluation of pathological grades and MVI in HCC.
PubMed, Web of Science, and Embase databases were searched for relevant studies published from inception to October 2021. Review Manager 5.3 was used to summarize standardized mean differences (SMDs) of mean kurtosis (MK), mean diffusivity (MD), tissue diffusivity (D), pseudo diffusivity (D*), perfusion fraction (f), mean apparent diffusion coefficient (ADCmean), and minimum apparent diffusion coefficient (ADCmin). Stata12.0 was used to pool the sensitivity, specificity, and area under the curve (AUC). Overall, 42 up-to-standard studies with 3,807 cases of HCC were included in the meta-analysis.
The SMDs of ADCmean, ADCmin, and D values, but not those of D* and f values, significantly differed between well, moderately, and poorly differentiated HCC ( < 0.01). The sensitivity, specificity, and AUC of the MK, D, ADCmean, and ADCmin for preoperative prediction of poorly differentiated HCC were 69%/94%/0.89, 87%/80%/0.89, 82%/75%/0.86, and 83%/64%/0.81, respectively. In addition, the sensitivity, specificity, and AUC of the D and ADCmean for preoperative prediction of well-differentiated HCC were 87%/83%/0.92 and 82%/88%/0.90, respectively. The SMDs of ADCmean, ADCmin, D, MD, and MK values, but not f values, showed significant differences ( < 0.01) between MVI-positive (MVI+) and MVI-negative (MVI-) HCC. The sensitivity and specificity of D and ADCmean for preoperative prediction of MVI+ were 80%/80% and 74%/71%, respectively; the AUC of the D (0.87) was significantly higher than that of ADCmean (0.78) ( = -2.208, = 0.027). Sensitivity analysis showed that the results of the above parameters were stable and reliable, and subgroup analysis confirmed a good prediction effect.
DKI parameters (MD and MK) and IVIM-DWI parameters (D value, ADCmean, and ADCmin) can be used as a noninvasive and simple preoperative examination method to predict the grade and MVI in HCC. Compared with ADCmean and ADCmin, MD and D values have higher diagnostic efficacy in predicting the grades of HCC, and D value has superior diagnostic efficacy to ADCmean in predicting MVI+ in HCC. However, f value cannot predict the grade or MVI in HCC.
目前，在预测肝细胞癌（HCC）的病理分级和微血管侵犯（MVI）方面，扩散峰度成像（DKI）、体素内不相干运动（IVIM）和扩散加权成像（DWI）的参数存在争议。本研究的目的是调查和比较DKI和IVIM-DWI参数对HCC病理分级和MVI术前评估的预测能力。
检索PubMed、Web of Science和Embase数据库中从建库至2021年10月发表的相关研究。使用Review Manager 5.3总结平均峰度（MK）、平均扩散率（MD）、组织扩散率（D）、伪扩散率（D*）、灌注分数（f）、平均表观扩散系数（ADCmean）和最小表观扩散系数（ADCmin）的标准化均数差（SMD）。使用Stata12.0汇总敏感性、特异性和曲线下面积（AUC）。总体而言，42项符合标准的研究共3807例HCC患者被纳入荟萃分析。
在高分化、中分化和低分化HCC之间，ADCmean、ADCmin和D值的SMD有显著差异（<0.01），而D*和f值的SMD无显著差异。MK、D、ADCmean和ADCmin术前预测低分化HCC的敏感性、特异性和AUC分别为69%/94%/0.89、87%/80%/0.89、82%/75%/0.86和83%/64%/0.81。此外，D和ADCmean术前预测高分化HCC的敏感性、特异性和AUC分别为87%/83%/0.92和82%/88%/0.90。在MVI阳性（MVI+）和MVI阴性（MVI-）的HCC之间，ADCmean、ADCmin、D、MD和MK值的SMD有显著差异（<0.01），而f值的SMD无显著差异。D和ADCmean术前预测MVI+的敏感性和特异性分别为80%/80%和74%/71%；D的AUC（0.87）显著高于ADCmean的AUC（0.78）（z=-2.208，P=0.027）。敏感性分析表明上述参数结果稳定可靠，亚组分析证实预测效果良好。
DKI参数（MD和MK）和IVIM-DWI参数（D值、ADCmean和ADCmin）可作为一种无创且简便的术前检查方法来预测HCC的分级和MVI。与ADCmean和ADCmin相比，MD和D值在预测HCC分级方面具有更高的诊断效能，D值在预测HCC的MVI+方面比ADCmean具有更高的诊断效能。然而，f值无法预测HCC的分级或MVI。
