Gd-EOB-DTPA增强MRI预测肝细胞癌CK19表达

【目的】探讨术前Gd-EOB-DTPA增强MRI影像特征在预测肝细胞癌细胞角蛋白19（CK19）表达中的价值。【方法】回顾性分析经手术后病理证实单发肝细胞癌（HCC）102例患者术前Gd-EOB-DTPA增强MRI资料，其中男94例，女8例。102例中CK19阳性25例，CK19阴性77例。所有的患者术前均行Gd-EOB-DTPA增强MRI检查，分析其影像征象，包括病变的大小、边缘、增强扫描动脉期瘤内血管、动脉期信号、增强方式、动脉期瘤周异常灌注、囊变坏死、出血、脂肪、包膜、脉管侵犯、淋巴结转移、门脉期/延迟期分隔、弥散加权成像（DWI）靶征、肝胆期（HBP）瘤周低信号、HBP靶征、T1值及T1降低率等；并分析这些征象与CK19表达的相关性。【结果】动脉期信号（P=0.013）、动脉期环形强化（P=0.018）、DWI靶征（P=0.001）、HBP靶征（P=0.005）与肝细胞癌CK19的表达密切相关。小于5cm的单发HCC出现延迟强化的分隔与CK19表达有相关性（P=0.042）。其中DWI靶征是肝细胞癌CK19表达阳性的独立危险因素（P=0.001，OR=4.875，95%CI：1.838~12.927）。【结论】术前Gd-EOB-DTPA增强MRI有助于预测HCC的CK19表达。

Preoperative Prediction of the Expression of CK19 in Hepatocellular Carcinoma by Gd-EOB-DTPA Enhanced MRI

【Objective】 To investigate the predictive value of preoperative Gd- EOB- DTPA enhanced MRI in the expression of cytokeratin 19（CK19）in hepatocellular carcinoma（HCC）.【Methods】A total of 102 patients，including 94 male and 8 female，with single HCC confirmed by pathology after operation who underwent preoperative enhanced MRI were retrospectively analyzed. A total of 25 were CK19-positive HCC and 77 were CK19-negative HCC. Two radiologists evaluated MR features including tumor size，tumor margin，intratumoral vessels，signal intensity（SI）on arterial phase （AP） ，enhancement pattern ，arterial rim enhancement ，peritumoral enhancement ，internal cystic or necrotic portion，hemorrhage，intratumoral fat，tumor capsule，vascular invasion，lymph node metastasis，intratumoral septum， target sign on diffusion weighted imaging（DWI）or hepatobiliary phase（HBP），peritumor hypointensity，SI on ADC，SI on HBP ，T1 relaxation times and T1 reduction rate between pre- and post- contrast enhancement. The associations between these imaging features and CK19 expression were investigated. 【Results】SI on AP（P = 0.013），arterial rim enhancement（P = 0.018），target sign on DWI（P = 0.001）and target sign on HBP（P = 0.005）were significantly associated with CK19 expression. Delayed enhanced intratumoral septum（P = 0.042）was associated with CK19 expression between HCCs less than 5 cm. Target sign on DWI（P = 0.001，OR = 4.875，95%CI：1.838~12.927）were independent significant factors of CK19- positive HCC.【Conclusion】Preoperative enhanced MRI with Gd- EOB- DTPA is helpful to predict CK19 expression of HCC.