Abstract: Objective To explore the clinical diagnostic efficacy of enhanced magnetic resonance imaging combined with serum AFP and protein induced by vitamin K absence or antagonist-II（PIVKA-Ⅱ） in the diagnosis of patients with hepatocellular carcinoma （HCC）. Methods A retrospective study was conducted on 82 patients with chronic liver diseases admitted to the First Hospital affiliated to Suzhou University between December 2015 and September 2017. 56 patients with HCC and 26 patients with chronic liver diseases （including 13 cases of liver cirrhosis and 13 cases of liver cyst） were diagnosed pathologically. All patients received serum AFP and PIVKA Ⅱ detection,as well as Gd-EOB-DTPA enhanced magnetic resonance imaging scans. Gd-EOB-DTPA enhanced magnetic resonance imaging scans were read by 3 radiologists,and the image rendering “fast in and fast out” and “low signal” in liver specific stage was defined as the characteristics of HCC. Serum AFP level was detected by roche cobas^® e type 601 automatic electrochemical luminescence immunoassay system testing,and serum PIVKA Ⅱ level was detected by using LUMIPULSE G1200 automatic immune analyzer and enzyme chemiluminescence method. Chi-square test was applied to detect the diagnosis efficacy among different parameters,and multiple independent samples nonparametric rank test was applied to compare serum AFP and PIVKA-Ⅱ levels. The sensitivity（Se）,specificity （Sp） and accuracy （Ac） were evaluated by the area under the ROC （AUC）. Results Serum AFP and PIVKA-Ⅱ levels in patients with HCC were 34.5（4.5,594.9） ng/ml and 63.5（25.0,2082.0） Mau/ml,significantly higher than 【3.4（2.2,11.6） ng/ml and 23.0 （18.8,28.0） Mau/ml,P<0.01】 in patients with chronic liver diseases;the area under ROC curve of serum AFP,PIVKA-Ⅱ levels and MRI in diagnosing HCC were 0.763,0.815,and 0.907,respectively;the cut-off-value of serum AFP level was 14.4 ng/ml,with Se,Sp and Ac of HCC diagnosis were 64.3%,84.6% and 67.4%,respectively,that of serum PIVKA-Ⅱ level was 40.5 Mau/ml,with Se,Sp and Ac of HCC diagnosis were 62.5%,100.0% and 74.4%,and the Se,Sp and Ac of HCC diagnosis by enhanced magnetic resonance imaging were 92.9%,88.5% and 91.5%;taking any one parameter among the three positive as the diagnostic criteria,the Se,Sp and Ac of HCC diagnosis were 98.2%,61.5% and 86.6%,while taking all three parameters positive as the diagnostic criteria,the Se,Sp and Ac of HCC diagnosis were 50.0%,100.0% and 50.0%. Conclusion The combination of serum AFP and PIVKA-Ⅱ detection and MRI in diagnosis of patients with HCC is efficacious,and the early diagnosis might be hard at present,which should be investigated in the future.

Key words: Hepatocellular carcinoma, Alpha fetoprotein, Protein induced by vitamin K absence or antagonist-II, Magnetic resonance imaging, Diagnosis