■探讨体素内不相干运动(IVIM)和增强T2*加权血管造影(ESWAN)联合应用对肝细胞癌(HCC)微血管侵犯(MVI)术前预测的价值。
■76例经病理证实的HCC患者,分为MVI阳性组(n=26)和MVI阴性组(n=50)。常规MRI,IVIM,和ESWAN序列进行。将三个感兴趣区域(ROI)放置在D上病变的最大轴向切片上,D*,和从IVIM序列导出的f图,和从ESWAN序列导出的R2*映射,还自动测量了来自ESWAN序列的相位图的肿瘤内敏感性信号(ITSS)。绘制受试者工作特征(ROC)曲线以评估预测MVI的能力。单因素和多因素logistic回归用于筛选临床和影像学信息中的独立风险预测因子。Delong检验用于比较曲线下面积(AUC)之间的差异。
■MVI阴性组的D和D*值均明显高于MVI阳性组(P=0.038,P=0.023),MVI阴性组分别为0.892×10-3(0.760×10-3,1.303×10-3)mm2/s和0.055(0.025,0.100)mm2/s,MVI阳性组分别为0.591×10-3(0.372×10-3,0.824×10-3)mm2/s和0.028(0.006,0.050)mm2/s,分别。MVI阴性组的R2*和ITSS值明显低于MVI阳性组(P=0.034,P=0.005),在MVI阴性组中分别为29.290(23.117,35.228)Hz和0.146(0.086,0.236),MVI阳性组为43.696(34.914,58.083)Hz和0.199(0.155,0.245),分别。经过单变量和多变量分析,只有法新社(赔率比,0.183;95%CI,0.041~0.823;P=0.027)是预测MVI状态的独立危险因素。AFP的AUC,D,D*,R2*,预测MVI的ITSS分别为0.652、0.739、0.707、0.798和0.657。IVIM的AUC(D+D*),ESWAN(R2*+ITSS),预测MVI的组合(D+D*+R2*+ITSS)分别为0.772、0.800和,分别为0.855。当IVIM与ESWAN结合使用时,性能得到改善,灵敏度为73.1%,特异性为92.0%(临界值:0.502),AUC明显高于AFP(P=0.001),D(P=0.038),D*(P=0.023),R2*(P=0.034),和ITSS(P=0.005)。
■IVIM和ESWAN参数在预测HCC患者MVI方面显示出良好的疗效。IVIM和ESWAN的组合可能有助于临床术前对MVI的无创性预测。
UNASSIGNED: To investigate the value of the combined application of intravoxel incoherent motion (IVIM) and enhanced T2*-weighted angiography (ESWAN) for preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC).
UNASSIGNED: 76 patients with pathologically confirmed HCC were retrospectively enrolled and divided into the MVI-positive group (n=26) and MVI-negative group (n=50). Conventional MRI, IVIM, and ESWAN sequences were performed. Three region of interests (ROIs) were placed on the maximum axial slice of the lesion on D, D*, and f maps derived from IVIM sequence, and R2* map derived from ESWAN sequence, and intratumoral susceptibility signal (ITSS) from the phase map derived from ESWAN sequence was also automatically measured. Receiver operating characteristic (ROC) curves were drawn to evaluate the ability for predicting MVI. Univariate and multivariate logistic regression were used to screen independent risk predictors in clinical and imaging information. The Delong\'s test was used to compare the differences between the area under curves (AUCs).
UNASSIGNED: The D and D* values of MVI-negative group were significantly higher than those of MVI-positive group (P=0.038, and P=0.023), which in MVI-negative group were 0.892×10-3 (0.760×10-3, 1.303×10-3) mm2/s and 0.055 (0.025, 0.100) mm2/s, and in MVI-positive group were 0.591×10-3 (0.372×10-3, 0.824×10-3) mm2/s and 0.028 (0.006, 0.050)mm2/s, respectively. The R2* and ITSS values of MVI-negative group were significantly lower than those of MVI-positive group (P=0.034, and P=0.005), which in MVI-negative group were 29.290 (23.117, 35.228) Hz and 0.146 (0.086, 0.236), and in MVI-positive group were 43.696 (34.914, 58.083) Hz and 0.199 (0.155, 0.245), respectively. After univariate and multivariate analyses, only AFP (odds ratio, 0.183; 95% CI, 0.041-0.823; P = 0.027) was the independent risk factor for predicting the status of MVI. The AUCs of AFP, D, D*, R2*, and ITSS for prediction of MVI were 0.652, 0.739, 0.707, 0.798, and 0.657, respectively. The AUCs of IVIM (D+D*), ESWAN (R2*+ITSS), and combination (D+D*+R2*+ITSS) for predicting MVI were 0.772, 0.800, and, 0.855, respectively. When IVIM combined with ESWAN, the performance was improved with a sensitivity of 73.1% and a specificity of 92.0% (cut-off value: 0.502) and the AUC was significantly higher than AFP (P=0.001), D (P=0.038), D* (P=0.023), R2* (P=0.034), and ITSS (P=0.005).
UNASSIGNED: The IVIM and ESWAN parameters showed good efficacy in prediction of MVI in patients with HCC. The combination of IVIM and ESWAN may be useful for noninvasive prediction of MVI before clinical operation.