【摘要】 目的 探讨基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI定性、定量特征术前预测血管包裹肿瘤细胞巢(VETC)阳性肝细胞癌(HCC)的价值。方法 回顾性分析经病理确诊HCC患者234例,其中VETC阳性101例,VETC阴性133例,按照7:3的比例将所有患者随机分为训练组和验证组。应用训练组数据构建预测VETC阳性的HCC预测模型,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)验证模型的诊断效能,绘制校准曲线图验证模型的校准度。结果 多因素logistic回归分析预测VETC阳性HCC的独立危险因素:门脉期周边廓清[比值比(OR)6.493],坏死或缺血严重(OR 4.756),移行期或肝胆期靶征(OR 0.307),病灶与肝实质的信号强度比(LLR)动脉期(OR 0.074)。训练组预测VETC阳性HCC的AUC 0.790[95%置信区间(CI)0.720～0.859];验证组预测VETC阳性HCC的AUC 0.779 (95%CI 0.668～0.889)。校准曲线图显示校准曲线(斜率0.91)与理想曲线几乎重合,说明预测模型校准度较好。结论 基于Gd-EOB-DTPA增强MRI定性、定量特征对于术前预测VETC阳性HCC具有重要价值,门脉期周边廓清、病灶坏死或缺血严重、移行期或肝胆期靶征、LLR动脉期是VETC阳性HCC的独立危险因素。更多还原

【Abstract】 Objective To investigate the value of qualitative and quantitative characteristics of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA) enhanced MRI in preoperative prediction of vessels encapsulating tumor clusters(VETC) pattern in hepatocellular carcinoma(HCC).Methods A total of 234 patients diagnosed with HCC by pathology were analyzed retrospectively.A total of 101 VETC-positive HCC patients and 133 VETC-negative HCC patients were included.All patients were divided into training group and validation group according to 7:3.The training group data were used to construct a prediction model for VETC-positive HCC.Receiver operating characteristic(ROC) curve was drawn and the area under the curve(AUC) was calculated to verify the diagnostic efficiency of the model.Calibration curve was drawn to verify the calibration of the model.Results Multivariate logistic regression analysis predicted the independent risk factors for VETC-positive HCC:portal phase peripheral washout [odds ratio(OR)6.493],necrosis or severe ischemia(OR 4.756),targetoid transitional phase or hepatobiliary phase(OR 0.307),and lesion to liver signal intensity ratio(LLR) on arterial phase(OR 0.074).The AUC of the training group in predicting VETC-positive HCC was 0.790 [95% confidence interval(CI) 0.720-0.85 9].The AUC of the validation group in predicting VETC-positive HCC was 0.779(95%CI 0.668-0.889).The calibration curve diagram showed that the calibration curve(the slope was 0.91) almost coincides with the ideal curve,indicating that the prediction model had better calibration.Conclusion The qualitative and quantitative characteristics of Gd-EOB-DTPA enhanced MRI can be used to predict VETC-positive HCC preoperatively,the independent risk factors of VETC include portal phase peripheral washout,necrosis or severe ischemia,targetoid transitional phase or hepatobiliary phase,and LLR on arterial phase.更多还原