利用同步多层扩散峰度成像对肝细胞癌早期复发进行术前预测。

Preoperative prediction of early recurrence in hepatocellular carcinoma using simultaneous multislice diffusion kurtosis imaging.

作者信息

Wu Yingyi, Ye Zheng, Yang Ting, Yao Shan, Chen Jie, Yin Ting, Song Bin

机构信息

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

MR Collaborations, Siemens Healthineers Ltd., Chengdu, China.

出版信息

Eur Radiol. 2025 May 6. doi: 10.1007/s00330-025-11633-x.

DOI:10.1007/s00330-025-11633-x

PMID:40328957

Abstract

OBJECTIVE

This study aimed to evaluate the value of simultaneous multislice diffusion kurtosis imaging (SMS-DKI) for predicting early recurrence (within 2 years) in hepatocellular carcinoma (HCC) and to develop a predictive model.

MATERIALS AND METHODS

This prospective study included 67 HCC patients who underwent SMS-DKI on a 3-T MRI between June 2021 and January 2023. Diffusion parameters, including the apparent diffusion coefficient (ADC), SMS-mean kurtosis (SMS-MK), and SMS-mean diffusivity (SMS-MD), along with radiological features, were analyzed. Logistic regression models were used to predict early recurrence, internally validated using 10-fold cross-validation, and assessed using AUC, calibration curves, and decision curve analysis (DCA).

RESULTS

Among 67 patients (58 males; mean age, 53.5 ± 9.9 years), 30 (44.8%) experienced early recurrence. The early recurrence had significantly lower ADC (1.12 vs 1.22 × 10 mm/s) and SMS-MD (1.45 vs 1.70 × 10 mm/s), and higher SMS-MK (0.91 vs 0.75). SMS-MK showed the highest AUC (0.90, 95% CI: 0.80-0.96). Multivariate analysis identified SMS-MK (OR = 3.43 [1.31-8.89]), tumor size (OR = 4.22 [1.58-7.76]), non-smooth tumor margin (OR = 2.68 [1.58-7.96]), and complete capsule (OR = 0.22 [0.02-0.79]) as independent predictors of early recurrence. Based on these four parameters, the final model achieved an AUC of 0.94 (95% CI: 0.88-1.00). Calibration curves and DCA confirmed clinical utility.

CONCLUSION

SMS-DKI enhances early recurrence prediction in HCC. The predictive model, incorporating SMS-MK, tumor size, and key radiological features, demonstrated good prognostic value.

KEY POINTS

Question Can SMS-DKI predict HCC early recurrence within 2 years post-surgery? Findings Higher SMS-MK, larger tumor size, non-smooth margins, and incomplete capsule predict HCC early recurrence (model AUC = 0.94). Clinical relevance Integrating preoperative SMS-DKI biomarkers (SMS-MK) with tumor size and capsule status stratifies early HCC recurrence risk, guiding surgical planning and postoperative management.

摘要

目的

本研究旨在评估同时多层扩散峰度成像（SMS-DKI）对预测肝细胞癌（HCC）早期复发（2年内）的价值，并建立一个预测模型。

材料与方法

这项前瞻性研究纳入了67例在2021年6月至2023年1月期间于3-T磁共振成像（MRI）上接受SMS-DKI检查的HCC患者。分析了扩散参数，包括表观扩散系数（ADC）、SMS平均峰度（SMS-MK）和SMS平均扩散率（SMS-MD），以及放射学特征。采用逻辑回归模型预测早期复发，通过10折交叉验证进行内部验证，并使用曲线下面积（AUC）、校准曲线和决策曲线分析（DCA）进行评估。

结果

67例患者（58例男性；平均年龄53.5±9.9岁）中，30例（44.8%）发生早期复发。早期复发患者的ADC（1.12对1.22×10⁻³mm²/s）和SMS-MD（1.45对1.70×10⁻³mm²/s）显著降低，而SMS-MK（0.91对0.75）升高。SMS-MK显示出最高的AUC（0.90，95%可信区间：0.80-0.96）。多因素分析确定SMS-MK（比值比[OR]=3.43[1.31-8.89]）、肿瘤大小（OR=4.22[1.58-7.76]）、肿瘤边缘不光滑（OR=2.68[1.58-7.96]）和完整包膜（OR=0.22[0.02-0.79]）为早期复发的独立预测因素。基于这四个参数，最终模型的AUC为0.94（95%可信区间：0.88-1.00）。校准曲线和DCA证实了其临床实用性。

结论

SMS-DKI可提高HCC早期复发的预测能力。包含SMS-MK、肿瘤大小和关键放射学特征的预测模型显示出良好的预后价值。

要点

问题SMS-DKI能否预测HCC术后2年内的早期复发？研究结果较高的SMS-MK、较大的肿瘤大小、不光滑的边缘和不完整的包膜可预测HCC早期复发（模型AUC=0.94）。临床意义将术前SMS-DKI生物标志物（SMS-MK）与肿瘤大小和包膜状态相结合，可对早期HCC复发风险进行分层，指导手术规划和术后管理。