动态增强MRI定量参数术前评估原发性肝癌患者临床分期研究*

doi:10.3969/j.issn.1672-5069.2024.02.024

摘要/Abstract

摘要： 目的研究动态增强MRI(DCE-MRI)定量参数术前评估原发性肝癌(PLC)患者临床分期的价值。方法 2021年1月～2023年1月我院收治的PLC患者69例, 均接受DCE-MRI检查并计算灌注参数, 如转运常数(K^Trans)、速率常数(K_ep)和血管外细胞外间隙体积分数(V_e)。经细针穿刺活检或术后组织病理学检查, 综合评估中国肝癌分期(CNLC)。绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估DCE-MRI定量参数诊断PLC术前临床分期的价值。结果经病理学检查, 69例PLC患者均被诊断为肝细胞癌(HCC), DCE-MRI检查发现CNLCⅠ期17例, Ⅱ期21例, Ⅲa期29例, Ⅲb期2例;Ⅲ期HCC患者K^Trans和K_ep分别为(0.4±0.1)min^-1和(1.2±0.6)min^-1, 显著大于Ⅰ～Ⅱ期患者【分别为(0.3±0.1)min^-1和(0.6±0.4)min^-1, P<0.05】, 而V_e为(0.4±0.2), 显著小于Ⅰ～Ⅱ期患者【(0.5±0.2), P<0.05】;分别以K^Trans＞0.4 min^-1、V_e＜0.5和K_ep＞0.9 min^-1为截断点, 三者联合诊断Ⅲ期HCC患者的AUC为0.812(95% CI:0.706～0.918), 其敏感度为80.6%, 特异度为65.8%, 显著优于各指标单独诊断(P<0.05)。结论 DCE-MRI定量参数联合术前判断HCC患者临床分期具有一定的应用价值, 可为临床制定合理的治疗方案提供指导, 值得应用。

关键词: 原发性肝癌, 动态增强磁共振成像, 定量参数, 中国肝癌分期, 诊断

Abstract: Objective The aim of this study was to explore the preoperative determination of China liver cancer staging (CNLC) by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters in patients with primary liver cancer (PLC). Methods 69 patients with PLC were enrolled in our hospital between January 2021 and January 2023, and all received DCE-MRI examination pre-operationally. The perfusion parameters, such as the transfer constant (K^Trans), rate constant (K_ep) and extravascular extracellular space volume fraction (V_e), were calculated. The CNLC of patients was determined by fine needle aspiration biopsy or postoperative pathology. The receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was calculated to evaluate the efficacy of DCE-MRI quantitative parameters in diagnosing the preoperative staging of patients with PLC. Results The 69 patients with PLC were all diagnosed pathologically as hepatocellular carcinoma (HCC), and the DCE-MRI scan found the CNLC stageⅠ in 17 cases, stage Ⅱ in 21 cases, stage Ⅲa in 29 cases and stage Ⅲb in 2 cases; the K^Trans and K_ep in patients with stage Ⅲ were (0.4±0.1)min^-1 and (1.2±0.6)min^-1, both significantly higher than , while the V_e was (0.4±0.2), significantly less than in patients with stage Ⅰ/Ⅱ; the AUC was 0.812(95% CI:0.706-0.918), with the sensitivity of 80.6% and the specificity of 65.8%, when the K^Trans and K_ep were combined with the V_e in predicting the CNLC staging in patients with PLC, much superior to any parameter doing alone(P<0.05). Conclusion The quantitative parameters of DCE-MRI scan could to certain extent decide pre-operationally the clinical staging in patients with PLC, which might be a great help for appropriate management in this circumstance.

Key words: Hepatoma, Dynamic contrast-enhanced magnetic resonance imaging, Quantitative parameters, China liver cancer staging, Diagnosis

谢晶美, 刘浩, 李安, 李华, 陈苗苗, 郭宝琴, 石洋洋, 朱志敏, 郭晨光. 动态增强MRI定量参数术前评估原发性肝癌患者临床分期研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 255-258.

Xie Jingmei, Liu Hao, Li An, et al.. Preoperative determination of China liver cancer staging by dynamic contrast-enhanced MRI quantitative parameters in patients with primary liver cancer[J]. Journal of Practical Hepatology, 2024, 27(2): 255-258.

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动态增强MRI定量参数术前评估原发性肝癌患者临床分期研究^*

Preoperative determination of China liver cancer staging by dynamic contrast-enhanced MRI quantitative parameters in patients with primary liver cancer

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