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钆塞酸二钠增强磁共振成像预测增殖型肝细胞癌术前诊断的列线图模型及其价值研究

[Study of a nomogram model of gadoxetate disodium-enhanced magnetic resonance imaging for the preoperative diagnosis of proliferative hepatocellular carcinoma and its value].

作者信息

Chen F X, Guo D J, Xu Y, Cheng J, Li Y M, Chen G L, Li X M

机构信息

Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China 7T Magnetic Resonance Translational Medicine Research Center, Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China.

Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2025 Mar 20;33(3):227-236. doi: 10.3760/cma.j.cn501113-20240509-00246.

Abstract

To develop and explore the clinical value of a nomogram model for the preoperative diagnosis of proliferative hepatocellular carcinoma (HCC) based on gadoxetate disodium (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI). The preoperative Gd-EOB-DTPA-enhanced MRI data and clinical pathological data of patients with pathologically confirmed proliferative (178 cases) and non-proliferative type HCC (378 cases) from September 2017 to November 2022 were retrospectively collected. The MRI features and clinicopathological features of proliferative and non-proliferative type HCC were evaluated. Multivariate logistic regression analysis was used to determine the independent predictive factors of proliferative-type HCC. The nomogram prediction model was constructed using R software. The receiver operating characteristic curve (ROC) was used to evaluate its diagnostic efficacy. The calibration curve and decision curve analysis (DCA) were drawn to evaluate the calibration performance and clinical application value of the nomogram model. The optimal threshold for distinguishing high-risk from low-risk was determined using the Youden index. The survival prognosis of proliferative and non-proliferative type HCC was analyzed and compared using the Kaplan-Meier survival curve and the log-rank test. The measurement data were analyzed using the independent sample -test or the Mann-Whitney test. The count data were compared using the test. There were statistically significant differences in alpha-fetoprotein (AFP) levels (=17.244, <0.001), tumor morphology (=13.669, <0.001), intratumoral fatty degeneration (=10.495, =0.001), abnormal enhancement of peritumoral abnormalities during arterial phase (=37.662, <0.001), tumor capsule (=23.961, <0.001), intratumoral necrosis (=77.184,<0.001), intratumoral hemorrhage (=4.892,=0.027), peritumoral hypointense in hepatobiliary phase (=47.675,<0.001), rim arterial phase hyperenhancement (=115.976,<0.001), intratumoral artery (=15.528,<0.001) and intravenous tumor thrombus (=10.532,=0.001) between proliferative and non-proliferative type HCC groups. Multivariate logistic regression analysis showed that AFP>200 μg/L (=1.561, =0.044), no intratumoral fatty degeneration (=1.947, =0.033), intratumoral necrosis (=2.084, =0.003), peritumoral hypointensity in the hepatobiliary phase (=2.314, =0.001), and annular hyperenhancement in the arterial phase (=5.557, <0.001) were independent predictors for preoperative diagnosis of proliferative-type HCC. A nomogram model for preoperative prediction of proliferative type HCC was constructed based on the independent predictors. The area under the ROC curve model for predicting proliferative-type HCC was 0.772 (95%: 0.735-0.807), with a sensitivity of 69.1% and a specificity of 75.4%. The calibration curve and DCA curve showed superior calibration performance and clinical applicability of the nomogram model. The Kaplan-Meier curve showed that the recurrence free survival rate after liver resection was significantly lower in patients with proliferative-type HCC than that of non-proliferative-type HCC (<0.001), and the high-risk group was significantly lower than the low-risk group (<0.001). The construction of a nomogram model based on Gd-EOB-DTPA-enhanced MRI features combined with AFP >200μg/L can accurately diagnose proliferative-type HCC and predict its preoperative prognosis.

摘要

基于钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)开发并探索列线图模型用于增殖性肝细胞癌(HCC)术前诊断的临床价值。回顾性收集2017年9月至2022年11月期间病理确诊的增殖性(178例)和非增殖性HCC(378例)患者的术前Gd-EOB-DTPA增强MRI数据和临床病理数据。评估增殖性和非增殖性HCC的MRI特征和临床病理特征。采用多因素逻辑回归分析确定增殖型HCC的独立预测因素。使用R软件构建列线图预测模型。采用受试者操作特征曲线(ROC)评估其诊断效能。绘制校准曲线和决策曲线分析(DCA)以评估列线图模型的校准性能和临床应用价值。使用约登指数确定区分高风险和低风险的最佳阈值。采用Kaplan-Meier生存曲线和对数秩检验分析并比较增殖性和非增殖性HCC的生存预后。计量资料采用独立样本t检验或Mann-Whitney检验进行分析。计数资料采用χ²检验进行比较。增殖性和非增殖性HCC组之间的甲胎蛋白(AFP)水平(χ²=17.244,P<0.001)、肿瘤形态(χ²=13.669,P<0.001)、瘤内脂肪变性(χ²=10.495,P=0.001)、动脉期瘤周异常强化(χ²=37.662,P<0.001)、肿瘤包膜(χ²=23.961,P<0.001)、瘤内坏死(χ²=77.184,P<0.001)、瘤内出血(χ²=4.892,P=0.027)、肝胆期瘤周低信号(χ²=47.675,P<0.001)、边缘动脉期高增强(χ²=115.976,P<0.001)、瘤内动脉(χ²=15.528,P<0.001)和静脉瘤栓(χ²=10.532,P=0.001)差异有统计学意义。多因素逻辑回归分析显示,AFP>200μg/L(β=1.561,P=0.044)、无瘤内脂肪变性(β=1.947,P=0.033)、瘤内坏死(β=2.084,P=0.003)、肝胆期瘤周低信号(β=2.314,P=0.001)和动脉期环形高增强(β=5.557,P<0.001)是增殖型HCC术前诊断的独立预测因素。基于独立预测因素构建了增殖型HCC术前预测的列线图模型。预测增殖型HCC的ROC曲线模型下面积为0.772(95%CI:0.735-0.807),灵敏度为69.1%,特异度为75.4%。校准曲线和DCA曲线显示列线图模型具有良好的校准性能和临床适用性。Kaplan-Meier曲线显示,增殖型HCC患者肝切除术后无复发生存率显著低于非增殖型HCC患者(P<0.001),高风险组显著低于低风险组(P<0.001)。基于Gd-EOB-DTPA增强MRI特征联合AFP>200μg/L构建的列线图模型可准确诊断增殖型HCC并预测其术前预后。

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