【摘要】 目的 探讨钆塞酸二钠增强MRI动脉期不规则环形强化肝细胞癌（IRE-HCC）的病理学特征，分析其根治切除术后早期复发情况。资料与方法 回顾性收集2015年2月—2021年9月在南通市第三人民医院就诊且经手术病理证实的HCC 131例。依据钆塞酸二钠增强MRI动脉期强化方式分为IRE-HCC和非IRE-HCC。比较两组患者的临床、病理及影像资料。采用Logistic回归分析与IRE-HCC相关的临床、病理与影像学特征，Kaplan-Meier法评估HCC术后2年内早期无复发生存率，Cox回归分析HCC术后早期复发的危险因素。结果 CK19(OR=9.027,95%CI 2.533～32.170,P=0.001)、微血管侵犯（OR=3.606,95%CI 1.024～12.701,P=0.046）和扩散加权成像靶征（OR=10.370,95%CI 3.046～35.303,P=0.000）与IRE-HCC相关。IRE-HCC术后2年累积无复发生存率（24.1%）显著低于非IRE-HCC(55.9%，χ~2=19.971,P=0.000)。微血管侵犯（HR=2.206,95%CI1.152～4.226,P=0.017）和IRE(HR=2.454,95%CI 1.408～4.275,P=0.002)是HCC术后早期复发的独立预测指标。结论 IREHCC与CK19、微血管侵犯和扩散加权成像靶征相关，且术后早期复发率高、预后差。更多还原

【Abstract】 Purpose To investigate the pathological characteristics of hepatocellular carcinoma(HCC) with irregular rim-like arterial phase enhancement(IRE) using gadoxetic acid-enhanced, and its early recurrence prognostic significance after surgery. Materials and Methods This retrospective study included 131 patients with surgically confirmed HCCs who underwent gadoxetic acid-enhanced MRI from February 2015 to September 2021 in the Third People’s Hospital of Nantong. According to the enhancement pattern of gadoxetic acidenhanced MRI in arterial phase, HCC were divided into IRE-HCC and non-IRE-HCC. Clinical, pathological and imaging characteristics were compared between IRE-HCC and non-IRE-HCC. Logistic regression analyses were performed to identify clinical, pathological and imaging features associated with IRE-HCC. Early recurrence(within 2 years) was evaluated by using Kaplan-Meier analysis. Cox regression analysis was performed to determine independent predictors of early recurrence. Results Cytokeratin 19(CK19)(OR=9.027, 95% CI 2.533-32.170,P=0.001), microvascular invasion(OR=3.606, 95% CI 1.024-12.701, P=0.046) and diffusion weighted imaging target signs(OR=10.370, 95%CI 3.046-35.303, P=0.000) were independent predictors for IRE-HCC. The 2-year cumulative recurrence-free survival rate postoperative of IRE-HCC was 24.1%, which was significantly shorter than that of non-IRE-HCC(55.9%, χ2=19.971, P=0.000). Microvascular invasion(HR=2.206, 95% CI 1.152-4.226, P=0.017) and IRE(HR=2.454, 95% CI 1.408-4.275, P=0.002) were independent predictors of early postoperative recurrence of HCC. Conclusion IRE-HCC are associated with CK19, microvascular invasion and diffusion weighted imaging target signs, and have a high recurrence rate and poor prognosis in the early postoperative period.更多还原