肝细胞癌癌前病变富血供转化的风险分析

目的探讨慢性肝病患者钆塞酸二钠增强磁共振成像(MRI)诊断高度异型增生结节(HGDN)转化成富血供肝细胞肝癌(HCC)的危险因素。方法回顾性分析2012年1月至2014年12月期间行钆塞酸二钠增强MRI的患者2037例,筛选出51例有慢性肝病背景的HGDN,行至少2次随访钆塞酸二钠增强MRI扫描,并且在首次MRI前后1个月内行CT增强扫描,研究终点为HGDN转化成富血供HCC,截止时间为2019年4月。根据有无富血供转化分为转化组(A组)和未转化组(B组)。线性回归分析HGDN向富血供HCC转化可能的危险因素。结果A组36个结节,B组79个结节,富血供转化率31.3%(36/115)。单变量分析结节长径>10.2mm(P=0.034)、年增长率>2%(P<0.001)、含脂质成分(P=0.007),与其发生富血供转化具有相关性,多变量分析结节年增长率是发生富血供转化的独立危险因素(P<0.0001)。结论慢性肝病患者钆塞酸二钠增强MRI诊断HGDN年增长率可以作为向富血供转化的潜在预测因子。

Risk analysis for hypervascular transformation of precancerous lesion of hepatocellular carcinoma

Objective To investigate the risk factors for diagnosis of transformation of high-grade dysplastic nodules(HGDN)to hypervascular hepatocellular carcinoma(HCC)in patients with chronic liver disease with gadoxetate disodium-enhanced magnetic resonance imaging(MRI).Methods 2037 cases that underwent gadoxetate disodium-enhanced magnetic resonance imaging from January 2012 to December 2014 were retrospectively analyzed.51 cases of HGDN with a background of chronic liver disease were screened and followed-up for at least 2 times with gadoxetate disodium-enhanced MRI scans and contrast enhanced CT scans was performed within 1 month before and after the first MRI.The endpoint of study was transformation of HGDN to hypervascular hepatocellular carcinoma,with a deadline of April 2019.Transformation was divided into transformed(group A)and untransformed(group B)group according to the presence or absence of hypervascularization.Linear regression was used to analyze the possible risk factors for hypervascular transformation.Results There were 36 nodules in group A and 79 nodules in group B,and hypervascular transformation rate was 31.3%(36/115).On univariate analysis,the length and diameter of nodule was>10.2 mm(P=0.034),with annual growth rate>2%(P<0.001),and lipid content(P=0.007)was related to the occurrence of hypervascularity.On multivariate analysis,the annual growth rate of nodules was an independent risk factor for the occurrence of hypervascularity(P<0.0001).Conclusion The annual growth rate of HGDN in patients with chronic liver disease diagnosed with gadoxetate disodium-enhanced MRI imaging can be used as a potential predictor of hypervascularization.