扩散峰度成像预测肝细胞癌切除术后早期复发的价值

The Value of Diffusion Kurtosis Imaging in Predicting Post-surgery Early Recurrence of Hepatocellular Carcinoma

中文关键词:  肝细胞癌 扩散峰度成像 磁共振成像 预后

英文关键词:Hepatocellular carcinoma Diffusion kurtosis imaging Magnetic resonance imaging Prognosis

中文摘要:

      目的 使用扩散峰度成像（DKI）评价肝细胞癌及癌周肝实质浸润情况，探索其在预测肝癌切除术后早期复发中的价值。方法 前瞻性纳入55例行肝切除术的肝细胞癌（HCC）患者，依据随访情况分为早期复发（1年内复发）与非早期复发两组，搜集、评估患者临床信息和常规MR影像特征，定量测量DKI参数图获得肿瘤和癌周肝实质的平均扩散系数（MD）值、平均扩散峰度（MK）值。使用单因素和多因素logistic回归寻找早期复发的独立影响因素，采用受试者工作特征曲线（ROC曲线）分析评价定量参数诊断早期复发的效能。结果 单因素logistic回归中，高甲胎蛋白水平、高巴塞罗那分级、原发病灶数两个及以上、高级别HCC、癌周肝实质低MD、癌周肝实质高MK均与早期复发相关（P<0.05）。其中高级别HCC〔比值比（OR）=5.37，95%可信区间（CI）：1.01～28.50，P=0.048〕和癌周肝实质高MK（OR=5.38，95%CI：1.53～18.92，P=0.009）是早期复发的独立危险因素。癌周肝实质MK预测早期复发的ROC曲线下面积为0.79（P<0.001），其值为0.96时灵敏度、特异度分别为85.2%、64.3%。结论 DKI评价HCC癌周肝实质浸润情况对预测患者早期复发有中等预测价值，癌周肝实质MK联合HCC病理分级对判断患者早期复发有一定潜力。

英文摘要:

      Objective To determine the value of diffusion kurtosis imaging for predicting one-year early recurrence (ER) of hepatocellular carcinoma (HCC) after curative resection. Methods 55 HCC patients were enrolled into this prospective study and received preoperative magnetic resonance (MR) examination including diffusion kurtosis imaging (DKI). The patients were followed up for at least one year after curative resection. The morphological features of HCC were assessed using the conventional contrast-enhanced MR images. Mean diffusivity (MD) and mean kurtosis (MK) were calculated for the intratumoral and peritumoral regions. Univariate and multivariate logistic regression analyses were performed to assess the relative value of these parameters as a potential predictor of ER. Receiver operating characteristic (ROC) curve analyses were used to determine the diagnostic performance of these quantitative parameters. Results Increased alpha-fetoprotein (AFP), BCLC stage, tumor number (≥2), high grade HCC, peritumoral MK, and decreased peritumoral MD were associated with higher one-year ER of HCC （P<0.05）. The multivariate analyses confirmed that high grade HCC 〔odds ratio （OR)=5.37，95% confidence interval (CI)：1.01-28.50，P=0.048〕 and increased peritumoral MK (OR=5.38，95%CI：1.53-18.92，P=0.009) were independent risk factors for the ER of HCC. The area under curve was 0.79 (P<0.001) for peritumoral MK, with an optimal sensitivity of 85.2% and specificity of 64.3% at the cut-off of 0.96. Conclusion Peritumoral MK has moderate diagnostic performance in predicting ER of HCC. Higher peritumoral MK value in combination with high-grade HCC are potential biomarkers for predicting one-year ER of HCC.