摘要
目的:探讨钆塞酸二钠多模态MRI联合临床特征构建的列线图模型同时预测肝细胞癌(HCC)中CK19表达及微血管侵犯(MVI)的价值。方法:回顾性搜集经病理诊断为单发性HCC的106例患者的病例资料,术前均行钆塞酸二钠增强多模态MRI检查,且术后病理报告清晰描述CK19及MVI状态。将CK19/MVI双生物学标志物分为双阳组(CK19及MVI均为阳性,19例)与非双阳组(87例),比较两组间临床及影像特征的差异,通过多因素Logistic回归筛选独立预测因子,并通过R软件构建CK19/MVI双阳性表达的列线图模型。结果:临床特征中年龄、AFP、NLR、PLR在双阳组与非双阳组间差异有统计学意义(P<0.05),影像特征中T1rt-pre、T1rt-20 min、ADC值、肿瘤直径、肿瘤包膜、肿瘤边缘、坏死、瘤周强化、肝胆期瘤周低信号在两组间差异有统计学意义(P<0.05),其余参数在两组间差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示PLR、T1rt-20 min、肝胆期瘤周低信号是CK19/MVI双阳表达的独立预测因子,各预测因子的ROC曲线下面积(AUC)分别为0.729、0.706、0.708。建立的列线图预测模型AUC为0.854,校准预测曲线与标准曲线贴合尚可。结论:钆塞酸二钠增强多模态MRI联合临床特征术前能较好地同时预测CK19表达及微血管侵犯,并通过列线图模型为个体化预测提供参考。
Objective:To investigate the value of a nomogram for the simultaneous prediction of CK19 expression and microvascular invasion(MVI)in hepatocellular carcinoma(HCC),by integrating the clinical features with Gd-EOB-DTPA enhanced multimodal MRI.Methods:The data of 106 patients with pathological diagnosis of solitary HCC were retrospectively collected.All patients underwent preoperative Gd-EOB-DTPA enhanced multimodal MRI examination,and the postoperative pathological report clearly described CK19 immunohistochemistry and MVI.The CK19/MVI dual biomarkers were divided into"double-positive"group(19 cases)and non-"double-positive"group(87 cases).Statistical differences in clinical and imaging characteristics were compared between the two groups.Independent predictors were identified by multivariate logistic regression,and a nomogram was developed using R software to predict the CK19/MVI"double-positive"status in HCC.Results:In clinical features,there were significant differences in age,AFP,NLR,and PLR between"double-positive"and non-"double-positive"groups(P<0.05).In imaging features,T1rt-pre,T1rt-20min,ADC,tumor diameter,tumor capsule,tumor margin,necrosis,and peritumoral enhancement and peritumoral hypointensity on HBP were significantly different between the two groups(P<0.05),but there was no statistical difference in other parameters(P>0.05).Multivariate logistic regression analysis showed that PLR,T1rt-20min,and peritumoral hypointensity on HBP were independent predictors of CK19/MVI"double positive"expression The area under the receiver operating characteristic curve of each independent predictor were 0.729,0.706,and 0.708,respectively.The AUC of the nomogram is 0.854.The nomogram revealed excellent agreement between the corrected predictive curve and the ideal curve.Conclusion:Gd-EOB-DTPA enhanced multimodal MRI,in combination with clinical features,can better simultaneously predict CK19 expression and MVI before surgery,as well as provide individualized prediction through nomogram.
作者
刘子蔚
杨少民
张榕
李民安
周翠铷
李晓虹
陈伊凡
胡秋根
LIU Zi-wei;YANG Shao-min;ZHANG Rong(Department of Radiology,Shunde Hospital,Southern Medical University(The First People’s Hospital of Shunde),Guangdong 528308,China)
出处
《放射学实践》
CSCD
北大核心
2024年第5期598-604,共7页
Radiologic Practice
基金
广东省中医药局科研项目(20241312)
广东省医学科学技术研究基金项目(A2024022、A2021483)
佛山市自筹经费类科技计划项目(2320001006750)
南方医科大学顺德医院科研启动项目(SRSP2021021,SRSP2023008)。
关键词
肝细胞癌
钆塞酸二钠
磁共振成像
细胞角蛋白19
微血管侵犯
Hepatocellular carcinoma
Gd-EOB-DTPA
Magnetic resonance imaging
Cytokeratin 19
Microvascular invasion
