背景:准确预测肝细胞癌(HCC)分级可能有助于合理选择治疗策略。乙氧基苯二亚乙基三胺五乙酸(Gd-EOB-DTPA)增强T1映射和表观扩散系数(ADC)值预测HCC等级的组合的诊断功效需要进一步验证。
目的:本研究旨在评估Gd-EOB-DTPA增强的T1映射能力和ADC值,无论是单独还是组合,区分不同等级的HCC。
方法:2017年7月至2020年2月,96例患者(男性,83岁;平均年龄,53.67岁;年龄范围,29-71岁)临床诊断为HCC被纳入本研究。所有患者均接受Gd-EOB-DTPA增强磁共振成像(MRI,包括T1映射序列)在手术或活检之前。根据病理结果分为3组(其中高分化肝癌24例,59例中分化肝癌,13例和低分化的HCC)。计算并比较不同分级HCC组之间的平均Gd-EOB-DTPA增强T1值(ΔT1=[(T1pre-T1post)/T1pre]×100%)和ADC值。特征曲线下面积(AUC),诊断阈值,灵敏度,并分析了ΔT1和ADC对鉴别诊断的特异性。
结果:高分化的HCC的平均值&#916;T1为58%,中等分化的HCC为50%,分化差的HCC为43%。ΔT1显示各组间有统计学差异(P<0.001)。3组的平均ADC值为1.11×10-3mm2/s,0.91×10-3mm2/s,0.80×10-3mm2/s,分别。ADC组间差异有统计学意义(P<0.001)。在区分高分化组和中分化组时,ΔT1的AUC为0.751(95%CI:0.642,0.859),ADC的AUC为0.782(95%CI:0.671,0.894),联合模型的AUC为0.811(95%CI:0.709,0.914)。在区分低分化组和中分化组时,ΔT1的AUC为0.768(95%CI:0.634,0.902),ADC的AUC为0.754(95%CI:0.603,0.904),联合模型的AUC为0.841(95%CI:0.729,0.953)。
结论:Gd-EOB-DTPA增强T1作图,和ADC值对识别不同HCC分级的敏感性和特异性具有互补作用。Gd-EOB-DTPA增强MRIT1映射和ADC值的组合模型可以提高预测HCC分级的诊断性能。。
BACKGROUND: Accurately predicting the hepatocellular carcinoma (HCC) grade may facilitate the rational selection of treatment strategies. The diagnostic efficacy of the combination of Gadolinium ethoxybenzy diethylenetriamine pentaacetic (Gd-EOB-DTPA) enhancement T1 mapping and apparent diffusion coefficient (ADC) values in predicting HCC grade needs further validation.
OBJECTIVE: This study aimed to assess the capacity of Gd-EOB-DTPA-enhanced T1 mapping and ADC values, both individually and in combination, to discriminate between different grades of HCC.
METHODS: From July 2017 to February 2020, 96 patients (male, 83; mean age, 53.67 years; age range, 29-71 years) clinically diagnosed with HCC were included in the present study. All patients underwent Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI, including T1 mapping sequence) before surgery or biopsy. All the patients were categorized into 3 groups according to the pathological results (including 24 cases of well-differentiated HCCs, 59 cases of moderately differentiated HCCs, 13 cases of and poorly differentiated HCCs). The mean Gd-EOB-DTPA enhanced T1 values (ΔT1=[(T1pre-T1post)/T1pre]×100%) and ADC values between different grading groups of HCC were calculated and compared. The area under the characteristics curve (AUC), the diagnostic threshold, sensitivity, and specificity of ΔT1 and ADC for differential diagnosis were analyzed.
RESULTS: Mean ΔT1 was 58% for well-differentiated HCCs, 50% for moderately-differentiated HCCs, and 43% for poorly-differentiated HCCs. ΔT1 showed statistical differences between the groups (P<0.001). The mean ADC values of the 3 groups were 1.11×10-3 mm2/s, 0.91×10-3 mm2/s, and 0.80×10-3mm2/s, respectively. ADC showed statistical differences between the groups (P<0.001). In discriminating well- differentiated group from the moderately differentiated group, the AUC of ΔT1 was 0.751 (95% CI: 0.642, 0.859), the AUC of ADC was 0.782 (95% CI: 0.671, 0.894), the AUC of combined model was 0.811 (95% CI: 0.709, 0.914). In discriminating the poorly differentiated group from the moderately differentiated group, the AUC of ΔT1 was 0.768 (95% CI: 0.634, 0.902), the AUC of ADC was 0.754 (95% CI: 0.603, 0.904), and the AUC of the combined model was 0.841 (95% CI: 0.729, 0.953).
CONCLUSIONS: Gd-EOB-DTPA enhanced T1 mapping, and ADC values have complementary effects on the sensitivity and specificity for identifying different HCC grades. A combined model of Gd-EOB-DTPA-enhanced MRI T1 mapping and ADC values could improve diagnostic performance for predicting HCC grades..