摘要
目的:探讨^(18)F-氟代脱氧葡萄糖(^(18)F-FDG)PET/CT与MRI动态增强扫描术前预测肝细胞癌(HCC)微血管侵犯(m VI)的临床价值。方法:回顾性分析接受^(18)F-FDG PET/CT和MRI检查的108例HCC患者的临床病理资料和影像资料,分为m VI阳性组56例和阴性组52例。测量肿瘤最大标准摄取值(SUV_(max)),平均标准摄取值(SUV_(mean)),肿瘤SUV_(max)、SUV_(mean)与肝组织代谢参数比值(SUV_(max)/SUV_(max_liver)、SUV_(mean)/SUV_(mean_liver)和SUV_(max)/SUV_(mean_liver)),肿瘤代谢体积(MTV),糖酵解总量(TLG),肿瘤FDG摄取的异质性参数变异系数(COV)。MRI定性分析肿瘤边界、血供、肿瘤内血管造影征和肿瘤周围异常灌注。比较m VI阳性和阴性组组间各定量及定性指标的差异,采用ROC曲线分析定量参数指标诊断m VI阳性的效能,并比较各参数诊断效能(AUC)间的差异。结果:2组定量指标SUV_(mean)、SUV_(max)/SUV_(mean_liver)、SUV_(max)/SUV_(max_liver)、SUV_(mean)/SUV_(mean_liver)、MTV、TLG和COV差异均有统计学意义(均P<0.05);而SUV_(max)组间差异无统计学意义(P>0.05)。ROC曲线分析显示,各参数预测HCC合并m VI效能的AUC为0.614~0.673,各指标间差异均无统计学意义(均P>0.05)。2组定性参数中的肿瘤强化方式差异有统计学意义(P<0.05);而肿瘤边界、动脉期病灶内血管造影征和动脉期病灶周围肝实质异常灌注差异均无统计学意义(均P>0.05)。以COV和强化方式联合诊断的AUC为0.753(95%CI 0.658~0.847),敏感度78.6%,特异度65.4%,阴性预测值73.9%,阳性预测值71.0%,准确率72.2%;与单一定量指标的AUC差异均有统计学意义(均P<0.05)。结论:^(18)F-FDG PET/CT和MRI可用于术前预测HCC的m VI,联合肿瘤FDG摄取的异质性参数COV和肿瘤MRI强化模式可提高预测效能。
Objective:To investigate the predictive value for microvascular invasion(mVI)in hepatocellular carcinoma(HCC)by ^(18)F-FDG PET/CT and multiparameter MRI.Methods:A total of 108 HCC patients who underwent MRI and ^(18)F-FDG PET/CT examinations were retrospectively included in this study and divided into two groups,the mVI-positive group(56 cases)and the mVI-negtive group(52 cases).The quantitative parameters of HCC,SUV_(max),SUV_(mean),SUV_(max)/SUV_(max_liver),SUV_(mean)/SUV_(mean_liver),SUV_(max)/SUV_(mean_liver),metabolic tumor volume(MTV),total lesion glycolysis(TLG)and coefficient of variation(COV)were measured and calculated.The qualitative parameters of HCC,lesion border,blood supply,intratumor angiography and peritumor abnormal perfusion were evaluated and recorded on MRI.The quantitative parameters and the qualitative parameters between two groups were compared.The predictive value of each parameter for mVI was determined by ROC curve,and the AUC differences were compared.Results:There were significant differences in SUV_(mean),SUV_(max)/SUV_(mean_liver),SUV_(max)/SUV_(max_liver),SUV_(mean)/SUV_(mean_liver),MTV,TLG and COV between the two groups(all P<0.05),while there was no significant difference in SUV_(max)(P>0.05).ROC curve showed that these quantitative parameters had moderate diagnostic efficacy for HCC with mVI(AUC of 0.614~0.673),and the AUCs had no significant differences(all P>0.05).There was a significant difference in the enhancement pattern between the two groups(P<0.05),while there were no significant differences in tumor border,intratumor angiography and peritumor abnormal perfusion in the arterial phase(all P>0.05).Most HCCs with mVI(44/56,78.6%)demonstrated hypovascular lesions.Incorporating COV and the enhancement patterns as a hybrid criterion achieved a better predictive performance with an AUC of 0.753(95%CI 0.658~0.847),sensitivity of 78.6%,specificity of 65.4%,positive predictive value of 73.9%,negative predictive value of 71.0%,accuracy of 72.2%,which had significant differences with the qualitative parameters alone(all P<0.05).Conclusions:18F-FDG PET/CT and MRI can be used in the prediction of mVI in HCC preoperatively,incorporating COV and enhancement pattern can improve the predictive efficency.
作者
李笑笑
孙健
石华铮
刘春利
张文瑞
刘魏然
梅鑫
沈碧霞
LI Xiaoxiao;SUN Jian;SHI Huazheng;LIU Chunli;ZHANG Wenrui;LIU Weiran;MEI Xin;SHEN Bixia(Cloud Medical Imaging Diagnosis Center of Universal Medicine in Shanghai,Shanghai 200437,China)
出处
《中国中西医结合影像学杂志》
2023年第5期525-530,共6页
Chinese Imaging Journal of Integrated Traditional and Western Medicine
关键词
癌
肝细胞
微血管侵犯
^(18)F-FDG
PET/CT
磁共振成像
异质性
Carcinoma,hepatocellular
Microvascular invasion
Fluorine-18 fluorodeoxyglucose-positron emission tomography(^(18)F-FDG-PET)
Magnetic resonance imaging
Heterogeneity
