小肝癌中的微血管侵犯：术前弥散加权成像能否对其进行预测？
Microvascular invasion in small hepatocellular carcinoma: is it predictable with preoperative diffusion-weighted imaging?
作者信息
Xu Pengju, Zeng Mengsu, Liu Kai, Shan Yan, Xu Chen, Lin Jiang
机构信息
Department of Radiology, Shanghai Institute of Medical Imaging, Shanghai, China.
出版信息
J Gastroenterol Hepatol. 2014 Feb;29(2):330-6. doi: 10.1111/jgh.12358.
BACKGROUND AND AIM
The presence of microvascular invasion (MVI) is an independent risk factor affecting recurrence-free survival following surgical treatment for small hepatocellular carcinoma (HCC). Our aim in this study was to investigate whether diffusion-weighted imaging (DWI) could be useful in predicting MVI for small HCC.
METHODS
Breath-hold DWI (b-value 0, 500 s/mm(2) ) and gadopentate dimeglumine-enhanced dynamic imaging of preoperative magnetic resonance imaging of 109 surgically proven small HCCs from 92 patients were retrospectively analyzed. The signal intensity ratio on DWI and apparent diffusion coefficients (ADCs) for lesions were quantitatively measured. Signal intensity ratio and ADC of DWI, tumor size, tumor shape, tumor capsule, peritumoral enhancement on arterial phase images, and dynamic enhancement pattern were analyzed as radiological parameters reflecting MVI and were compared with histopathological references. The chi-square test, Fisher's exact test, Mann-Whitney U test, and the independent t-test were used for univariate analysis. To identify the independent predictors of MVI among these radiological parameters and to evaluate their diagnostic performance, multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed, respectively.
RESULTS
A univariate analysis showed that a lower ADC value (P = 0.005) and irregular circumferential enhancement (P = 0.020) showed statistically significant associations with MVI. A multiple logistic regression analysis showed that the ADC value and irregular circumferential enhancement were independent predictors of MVI. With a cut-off of 1.227 × 10(-3) mm(2) /s, the ADC value provided a sensitivity of 66.7% and a specificity of 78.6% in the prediction of MVI with an odds ratio of 7.63 (P < 0.01).
CONCLUSIONS
Lower ADC values (< 1.227 × 10(-3) mm(2) /s) on DWI with b-value of 0.500 s/mm(2) can be a useful preoperative predictor of MVI for small HCCs.
背景与目的
微血管侵犯（MVI）的存在是影响小肝细胞癌（HCC）手术治疗后无复发生存的独立危险因素。本研究的目的是探讨扩散加权成像（DWI）是否有助于预测小HCC的MVI。
方法
回顾性分析92例患者109个经手术证实的小HCC术前磁共振成像的屏气DWI（b值0、500 s/mm²）和钆喷酸葡胺增强动态成像。定量测量病变在DWI上的信号强度比和表观扩散系数（ADC）。将DWI的信号强度比和ADC、肿瘤大小、肿瘤形态、肿瘤包膜、动脉期图像上的瘤周强化及动态强化模式作为反映MVI的影像学参数进行分析，并与组织病理学参考结果进行比较。采用卡方检验、Fisher确切概率法、Mann-Whitney U检验和独立t检验进行单因素分析。为了在这些影像学参数中确定MVI的独立预测因素并评估其诊断性能，分别进行多因素logistic回归分析和受试者工作特征曲线分析。
结果
单因素分析显示，较低的ADC值（P = 0.005）和不规则的周边强化（P = 0.020）与MVI有统计学意义的关联。多因素logistic回归分析显示，ADC值和不规则的周边强化是MVI的独立预测因素。以1.227×10⁻³ mm²/s为截断值，ADC值在预测MVI时的灵敏度为66.7%，特异度为78.6%，比值比为7.63（P < 0.01）。
结论
b值为0.500 s/mm²的DWI上较低的ADC值（<1.227×10⁻³ mm²/s）可作为小HCC术前MVI的有用预测指标。
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