CT和MRI动态增强扫描诊断和评估原发性肝癌患者微血管浸润价值研究

doi:10.3969/j.issn.1672-5069.2024.01.028

摘要/Abstract

摘要： 目的研究使用电子计算机断层扫描(CT)和磁共振(MRI)动态增强扫描诊断和评估原发性肝癌(PLC)患者微血管浸润(MVI)的价值。方法 2020年1月～2023年1月我院收治的PLC患者50例,术前均接受腹部CT和MRI检查,记录肿瘤边缘模糊征象、瘤内新月征、静脉浸润的双预测因子(TTPVI)、门静脉癌栓(PVTT)和表观弥散系数(ADC)。行肝叶切除术治疗,取术后组织行病理学检查诊断MVI。结果经术后组织病理学检查,诊断肝细胞癌(HCC)32例和胆管细胞癌18例,存在MVI者29例,无MVI者21例;CT检查MVI患者肿瘤边缘模糊、局部外凸结节、包膜不完整、多结节融合、瘤内新月征、TTPVI和PVTT等影像学征象占比分别为82.8％、17.2％、31.0％、17.2％、13.8％、65.5％和17.2％,显著高于无MVI患者(分别为14.3％、4.8％、4.8％、4.8％、0.0%、9.5％和0.0%,P<0.05);MRI检查MVI患者肿瘤边缘模糊、局部结节、包膜不完整、多结节融合、瘤内新月征、TTPVI和PVTT等影像学征象占比为89.7％、24.1％、37.9％、27.6％、13.8％、72.4％和24.1％,显著高于无MVI患者(分别为23.8％、9.5％、9.5％、9.5％、0.0%、14.3％和0.0%,P<0.05);经Logistic回归分析显示,CT和MRI检查发现病灶边缘模糊、TTPVI和PVTT是PLC患者发生MVI的独立影响因素(P<0.05)。结论 CT和MRI动态增强扫描可通过特殊征象判断PLC患者MVI的存在,可帮助临床医生做出合理的诊治策略。

关键词: 原发性肝癌, 微血管浸润, 影像学检查, 诊断

Abstract: Objective The aim of this study was to investigate the dynamic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of microvascular invasion (MVI) in patients with primary liver cancer (PLC). Methods 50 patients with PLC were admitted to our hospital between January 2020 and January 2023, and all underwent plain and dynamic contrast-enhanced CT and MRI scan before operation. The blurry tumor margins, such as locally convex nodules, locally incomplete capsule, multi-nodule fusion, intra-tumor crescent sign, two-trait predictor of venous invasion (TTPVI), portal vein tumor thrombosis (PVTT) and apparent diffusion coefficient (ADC) were recorded. All patients underwent hepatectomy and the post-operational examination was conducted for the diagnosis of MVI. Results The postoperative histopathological examination found that among the 50 patients with PLC, there were 32 patients with hepatocellular carcinoma (HCC) and 18 patients with cholangiocellular carcinoma, with MVI positive in 29 cases and without MVI in 21 cases; the CT scan found that the proportions of the blurry tumor margins, locally convex nodules, locally incomplete capsule, multi-nodule fusion, intra-tumor crescent sign, TTPVI and PVTT among patients with MVI were 82.8%, 17.2%, 31.0%, 17.2%, 13.8%, 65.5% and 17.2%, all significantly higher than 14.3%, 4.8%, 4.8%, 4.8%, 0.0%, 9.5% and 0.0% (P<0.05) in patients without MVI; the MRI found that the proportions of the blurry tumor margins, locally convex nodules, locally incomplete capsule, multi-nodule fusion, intra-tumor crescent sign, TTPVI and PVTT among patients with MVI were 89.7%, 24.1%, 37.9%, 27.6%, 13.8%, 72.4% and 24.1%, all significantly higher than 23.8%, 9.5%, 9.5%, 9.5%, 0.0%, 14.3% and 0.0% (P<0.05) in patients without MVI; the Logistic regression analysis showed that the blurry tumor margins, TTPVI and PVTT were the independent risk factors for the existence of MVI in patients with PLC (P<0.05). Conclusion The special signs of dynamic contrast-enhanced CT and MRI scan could hint the existence of MVI, which might help the gastroenterologists make an appropriate management strategy.

Key words: Hepatoma, Microvascular invasion, CT, MRI, Dynamic contrast-enhanced scan, Diagnosis

丁建华, 张波, 邓国莉. CT和MRI动态增强扫描诊断和评估原发性肝癌患者微血管浸润价值研究[J]. 实用肝脏病杂志, 2024, 27(1): 109-112.

Ding Jianhua, Zhang Bo, Deng Guoli. Dynamic contrast-enhanced CT and MRI check-up in the diagnosis of microvascular invasion in patients with primary liver cancer[J]. Journal of Practical Hepatology, 2024, 27(1): 109-112.

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