国际医学放射学杂志2024，Vol.47Issue(5)：539-545,574,8.DOI:10.19300/j.2024.L21233
术前MRI特征对肝细胞癌血管包绕肿瘤团簇及微血管侵犯的评估
Assessment of vascular encapsulating tumor clusters and microvascular invasion in hepatocellular carcinoma based on preoperative MRI features
摘要
Abstract
Objective To investigate the value of the 2018 Liver Image Reporting and Data System(LI-RADS v2018)and other imaging features based on preoperative Gd-EOB-DTPA-enhanced MRI in predicting vascular encapsulating tumor clusters(VETC)and microvascular invasion(MVI)in hepatocellular carcinoma(HCC),constructing a predictive model and assessing its risk stratification capability.Methods This study retrospectively included 232 HCC patients who underwent curative liver resection.Based on the VETC and MVI status,patients were categorized into the VETC and MVI positive HCC group[VM(+)group](46 patients)and the VETC or MVI negative HCC group[non-VM(+)group](186 patients).Multivariate logistic regression analysis was used to identify the independent predictors of VM(+)HCC and to construct a combined model.The predictive efficacy of single predictors and the combined model was assessed using receiver operating characteristic(ROC)curves,and the area under the curve(AUC),sensitivity,and specificity were calculated.The predictor or model with the highest AUC was selected for survival analysis,and a statistical cutoff value for predictive probability was set based on the maximum Yoden index of the ROC curve to categorize HCC patients into high and low risk groups.Kaplan-Meier survival curves were used to evaluate recurrence-free survival(RFS)and early recurrence(ER)between the high-risk and low-risk groups,as well as between VM(+)and non-VM(+)HCC patients.Results Multivariate logistic regression analysis revealed that tumor size,peritumoral enhancement during the arterial phase,and peritumoral hypointensity during the hepatobilary phase were independent predictors of VM(+)HCC.The combined model incorporating these three factors achieved an AUC of 0.792,with sensitivity of 80.4％and specificity of 74.2％.DeLong's test showed that the AUC of the combined model for predicting VM(+)HCC was higher than that of any single predictor(all P＜0.05).Kaplan-Meier survival analysis demonstrated the RFS was shorter and the ER risk was higher in the VM(+)group compared to the non-VM(+)group,and similarly,the high-risk group predicted by the combined model had shorter RFS and higher ER risk than the low-risk group(P＜0.05).Conclusion The combined model based on tumor size,peritumoral enhancement during the arterial phase,and peritumoral hypointensity during the hepatobilary phase can be used for preoperative prediction of VM(+)HCC.The coexistence of VETC and MVI is associated with an increased risk of ER and decreased RFS following HCC resection.关键词
肝细胞癌/微血管侵犯/磁共振成像/肝脏影像报告和数据系统Key words
Hepatocellular carcinoma/Microvascular invasion/Magnetic resonance imaging/Liver imaging reporting and data system分类
医药卫生引用本文复制引用
刘子鑫,闫祖仪,张涛,张学琴,顾春燕,瞿琦,姜吉锋..术前MRI特征对肝细胞癌血管包绕肿瘤团簇及微血管侵犯的评估[J].国际医学放射学杂志,2024,47(5):539-545,574,8.基金项目
江苏省研究生科研与实践创新计划项目(SJCX23_1800) （SJCX23_1800）
江苏省研究型医院学会感染影像科研专项科技项目(GY202203) （GY202203）
南通市科技计划项目(MS22022056) （MS22022056）
