钆塞酸二钠增强MRI特征对肝细胞癌微血管侵犯的预测价值

目的 探讨术前钆塞酸二钠增强MRI特征预测肝细胞癌（HCC）微血管侵犯（MVI）的价值。 方法 回顾性分析83例经手术病理确诊的HCC病人的术前影像及临床资料,其中男75例,女8例,平均（57.6±11.4）岁。所有病人均进行了MRI平扫和增强检查,分析其常规MRI征象和肝胆期征象。根据术后病理结果将病人分为MVI阳性组30例及MVI阴性组53例。采用t检验或χ²检验比较2组间临床和影像特征的差异,将差异有统计学意义的特征纳入多因素Logistic回归分析,获得独立危险因素后分别建立单独预测模型及联合预测模型,采用受试者操作特征曲线评估不同模型的预测效能,计算其曲线下面积（AUC）,并采用DeLong检验比较不同模型预测MVI的AUC。 结果 与MVI阴性组相比,MVI阳性组的肝胆期肿瘤最大径、瘤周晕征、肿瘤边缘分型中的单结节外突/多结节融合型占比均更高,肿瘤信号强度比值较低;常规MRI征象中包膜不完整性、瘤周强化的占比更高;AFP水平大于MVI阴性组（均P<0.05）。多因素Logistic回归分析显示肝胆期的肿瘤最大径、瘤周晕征和单结节外突/多结节融合型均为HCC MVI的独立危险因素（OR值分别为1.424、26.998、6.144,均P<0.05）,肿瘤最大径越大、瘤周晕征阳性及单结节外突/多结节融合型表现的病人发生MVI的风险越高。联合预测模型、肿瘤最大径模型、单结节外突/多结节融合型模型和瘤周晕征模型预测MVI的AUC分别为0.926、0.803、0.792、0.823。联合模型预测MVI的敏感度、特异度和AUC值均最高,且AUC值分别高于肿瘤最大径模型、单结节外突/多结节融合型模型和瘤周晕征模型（均P<0.05）。 结论 钆塞酸二钠增强MRI上肿瘤最大径、单结节外突/多结节融合型和肝胆期瘤周晕征是预测MVI的独立危险因素,且三者联合预测效能更高。

Predicting microvascular invasion of hepatocellular carcinoma based on Gd-EOB-DTPA enhanced MRI features

Objective To explore the value of constructing model based on preoperative Gd-EOB-DTPA enhanced MRI features to predict microvascular invasion (MVI) of hepatocellular carcinoma. Methods The preoperative images and clinical data of 83 patients with HCC confirmed by surgery and pathology were analyzed retrospectively, including 75 males and 8 females, with an average age of 57.6±11.4 years. All patients underwent MRI plain scan and enhanced examination, and their routine MRI signs and hepatobiliary signs were analyzed. According to the postoperative pathological results, the patients were divided into MVI positive group of 30 cases and MVI negative group of 53 cases. Use t-test or χ² test and compare the differences of clinical and imaging features between the two groups, statistically significant features were included in multivariate Logistic regression analysis to obtain independent risk factors,and establish separate prediction models and joint prediction models for the obtained independent risk factors. The prediction efficiencies of different models were evaluated by receiver operating characteristic (ROC) curve, and the difference in area under the curve (AUC) was compared. The AUCs of MVI predicted by different models were compared by DeLong test. Result Compared with the MVI negative group, the MVI positive group had a higher proportion of the maximum diameter of hepatobiliary tumor, peritumoral halo sign, single nodule exon/multi nodule fusion type in the tumor margin classification, and a lower proportion of signal intensity ratio. In routine MRI signs, the proportion of incomplete capsule and peritumoral enhancement is higher; alpha fetoprotein (AFP) level was higher than that in MVI negative group (all P<0.05). Multivariate logistic regression analysis showed the maximum diameter of hepatobiliary tumor, peritumoral halo sign, and single nodule exophytic/multi nodule fusion type were independent risk factors of HCC MVI (OR 1.424, 26.998, 6.144, respectively, all P<0.05), and the larger the maximum diameter of hepatobiliary tumor, the positive peritumoral halo sign, and the patients with single nodule exodus/multi nodule fusion, the higher the risk of MVI. The AUCs of MVI predicted by combined prediction model, tumor maximum diameter, single nodule exophytic/multi nodule fusiontype, and HBP peritumoral halo sign modelwere 0.926, 0.803, 0.792 and 0.823, respectively. The sensitivity, specificity and AUC of MVI predicted by the combined model was the highest,andthe AUC of MVI predicted by the combined prediction model was significantly higher than that predicted by each singleindependent risk factor model (all P<0.05). Conclusion The maximum diameter of tumor, single nodule exophytic/multi nodule fusion type, and peritumoral halo sign on HCC Gd-EOB-DTPA enhanced MRI are independent risk factors for predicting MVI, and the prediction efficiency of the factors combined is higher.