【摘要】 目的研究肝细胞肝癌(简称肝癌)在钆塞酸二钠(Gd-EOB-DTPA)增强MRI中肝胆期信号表现与预后的关系。方法回顾性分析符合纳入标准的重庆医科大学附属第一医院2014年1月至2017年1月期间行手术切除并经病理学检查证实为肝癌患者的临床病理资料,根据其在Gd-EOB-DTPA增强MRI中肝胆期的信号表现分为均匀低信号组(简称低信号组)和不均匀高信号组(简称高信号组),比较2组间患者的无瘤生存时间及其影响因素。结果本研究共纳入77例肝癌患者,其中低信号组45例,高信号组32例。低信号组和高信号组间患者的年龄、性别、病因、肝功能、甲胎蛋白、分化程度、Child分级、病灶直径、病灶边界及病灶数目比较差异均无统计学意义(P>0.05),但高信号组分期更晚(P=0.001)。低信号组和高信号组无瘤生存时间分别为(17.0±9.8)个月和(12.4±10.4)个月,Kaplan-Meier生存曲线结果显示,低信号组的无瘤生存时间明显优于高信号组(P=0.020)。单因素分析后发现,除肝胆期信号外,其他混杂因素对肝癌患者的无瘤生存时间均无影响(P>0.05),进一步将临床上认为可能影响肝癌患者预后的肝胆期信号、BCLC分期及分化程度纳入Cox比例风险回归模型后发现,不均匀高信号仍是影响肝癌患者无瘤生存时间的危险因素(P=0.047)。结论肝癌在Gd-EOBDTPA增强MRI中肝胆期信号的表现与预后有关,不均匀高信号可能预示着更低的无瘤生存率。更多还原

【Abstract】 Objective To clarify relationship between signal heterogeneity on hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced MRI and prognosis of hepatocellular carcinoma(HCC). Methods From January 2014 to January 2017 in the First Affiliated Hospital of Chongqing Medical University, a total of 77 patients with the pathologically proved HCC underwent Gd-EOB-DTPA-enhanced MRI prior to surgery were included in this study. On the basis of the signal heterogeneity in the hepatobiliary phase, the included patients were designed to homogeneous hypointensity group and heterogeneous hyperintensity group. The disease-free survival time were compared between the 2 groups and it’s influencing factors were analyzed. Results Seventy-seven patients with HCC were included, including 45 cases of homogeneous hypointensity and 32 cases of heterogeneous hyperintensity. There were no significant differences in the age, gender, etiology, liver function, alpha-fetoprotein,differentiated degree, Child-Pugh grade, lesion diameter, lesion border, and number of lesions between the 2 groups(P>0.05). However, the HCC patients with heterogeneous hyperintensity had a later BCLC staging(P=0.001). The diseasefree survival time of the patients with homogeneous hypointensity and heterogeneous hyperintensity was(17.0±9.8)months and(12.4±10.4) months, respectively. The Kaplan-Meier survival curve showed that the disease-free survival time in the patients with homogeneous hypointensity was significantly better than that in the patients with heterogeneous hyperintensity(P=0.020). The results of univariate analysis showed that the other confounding factors had no effect on the disease-free survival time of patients with hepatocellular carcinoma(P>0.05) except for the signal of hepatobiliary phase(P<0.05). Furthermore, the hepatobiliary phase signal, BCLC stage, and degree of differentiation, which might be clinically considered as potentially influencing for the prognosis of patients with HCC, were included in the Cox multivariate proportional hazard regression model and found that the heterogeneous hyperintensity was still the risk factor of the disease-free survival rate in patients with HCC(P=0.047). Conclusion Signal heterogeneity on hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI is related to prognosis of patients with HCC, heterogeneous hyperintensity may indicate a lower disease-free survival rate.更多还原