Li Qian, Zhang Tong, Che Feng, Yao Shan, Gao Feifei, Nie Lisha, Tang Hehan, Wei Yi, Song Bin
Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
GE Healthcare, MR Research China, Beijing, China.
Eur Radiol. 2023 Aug;33(8):5222-5235. doi: 10.1007/s00330-023-09496-1. Epub 2023 Mar 9.
To explore whether intravoxel incoherent motion (IVIM) parameters could evaluate liver regeneration preoperatively.
A total of 175 HCC patients were initially recruited. The apparent diffusion coefficient, true diffusion coefficient (D), pseudodiffusion coefficient (D), pseudodiffusion fraction (f), diffusion distribution coefficient, and diffusion heterogeneity index (Alpha) were measured by two independent radiologists. Spearman's correlation test was used to assess correlations between IVIM parameters and the regeneration index (RI), calculated as 100% × (the volume of the postoperative remnant liver - the volume of the preoperative remnant liver) / the volume of the preoperative remnant liver. Multivariate linear regression analyses were used to identify the factors for RI.
Finally, 54 HCC patients (45 men and 9 women, mean age 51.26 ± 10.41 years) were retrospectively analyzed. The intraclass correlation coefficient ranged from 0.842 to 0.918. In all patients, fibrosis stage was reclassified as F0-1 (n = 10), F2-3 (n = 26), and F4 (n = 18) using the METAVIR system. Spearman correlation test showed D (r = 0.303, p = 0.026) was associated with RI; however, multivariate analysis showed that only D value was a significant predictor (p < 0.05) of RI. D and Dshowed moderate correlations with fibrosis stage (r = -0.361, p = 0.007; r = -0.457, p = 0.001). Fibrosis stage showed a negative correlation with RI (r = -0.263, p = 0.015). In the 29 patients who underwent minor hepatectomy, only the D value showed a positive association (p < 0.05) with RI, and a negative correlation with fibrosis stage (r = -0.360, p = 0.018). However, in the 25 patients who underwent major hepatectomy, no IVIM parameters were associated with RI (p > 0.05).
The D and D values, especially the D value, may be reliable preoperative predictors of liver regeneration.
• The D and D values, especially the D value, derived from IVIM diffusion-weighted imaging may be useful markers for the preoperative prediction of liver regeneration in patients with HCC. • The D and D values derived from IVIM diffusion-weighted imaging show significant negative correlations with fibrosis, an important predictor of liver regeneration. • No IVIM parameters were associated with liver regeneration in patients who underwent major hepatectomy, but the D value was a significant predictor of liver regeneration in patients who underwent minor hepatectomy.
探讨体素内不相干运动（IVIM）参数能否在术前评估肝再生情况。
最初纳入175例肝癌患者。由两名独立的放射科医生测量表观扩散系数、真扩散系数（D）、假扩散系数（D*）、假扩散分数（f）、扩散分布系数和扩散异质性指数（Alpha）。采用Spearman相关性检验评估IVIM参数与再生指数（RI）之间的相关性，RI计算方法为100%×（术后残余肝体积-术前残余肝体积）/术前残余肝体积。采用多元线性回归分析确定RI的相关因素。
最终，对54例肝癌患者（45例男性，9例女性，平均年龄51.26±10.41岁）进行回顾性分析。组内相关系数范围为0.842至0.918。所有患者使用METAVIR系统将纤维化阶段重新分类为F0-1（n=10）、F2-3（n=26）和F4（n=18）。Spearman相关性检验显示D（r=0.303，p=0.026）与RI相关；然而，多因素分析显示只有D值是RI的显著预测因子（p<0.05）。D和D*与纤维化阶段呈中度相关（r=-0.361，p=0.007；r=-0.457，p=0.001）。纤维化阶段与RI呈负相关（r=-0.263，p=0.015）。在29例行小范围肝切除术的患者中，只有D值与RI呈正相关（p<0.05），且与纤维化阶段呈负相关（r=-0.360，p=0.018）。然而，在25例行大范围肝切除术的患者中，没有IVIM参数与RI相关（p>0.05）。
D和D*值，尤其是D值，可能是可靠的肝再生术前预测指标。
• 源自IVIM扩散加权成像的D和D值，尤其是D值，可能是肝癌患者肝再生术前预测的有用标志物。• 源自IVIM扩散加权成像的D和D值与纤维化呈显著负相关，纤维化是肝再生的重要预测指标。• 大范围肝切除术患者中没有IVIM参数与肝再生相关，但小范围肝切除术患者中D值是肝再生的显著预测指标。
