三维磁共振弹性成像诊断肝癌纤维包膜形成

doi:10.3877/cma.j.issn.2095-3232.2019.03.017

目的

探讨磁共振弹性成像（MRE）在诊断肝细胞癌（肝癌）纤维包膜（FC）形成中的价值。

方法

回顾性分析2014年12月至2017年10月中山大学附属第三医院初诊的50例肝癌患者临床资料。其中男41例，女9例；平均年龄（49±10）岁。患者均签署知情同意书，符合医学伦理学规定。分别采用MRE测量肝癌硬度值和磁共振动态增强扫描（DCE-MRI）来诊断FC，以病理学检查结果为诊断金标准，将患者分为FC组（28例）与无FC组（22例），评估MRE诊断FC准确性。两组硬度值比较采用t检验，采用受试者工作特征（ROC）曲线和诊断试验评价MRE和DCE-MRI诊断FC的效能。

结果

FC组肝癌硬度值为（4.6±1.1）kPa，明显低于无FC组的（6.7±2.8）kPa（t=-2.853，P<0.05）。MRE诊断FC的ROC曲线下面积为0.737，最佳诊断界值为5.6 kPa，敏感度、特异度分别为0.89、0.68，诊断准确性为0.74。DCE-MRI诊断FC的敏感度、特异度分别为0.93、0.09，诊断准确性为0.56。

结论

MRE测量肝癌硬度值可较为准确地诊断肝癌FC形成，其诊断效能优于DCE-MRI。

关键词: 癌，肝细胞, 纤维包膜, 硬度值, 磁共振弹性成像, 诊断

Objective

To investigate the value of magnetic resonance elastography (MRE) in diagnosing the fibrous capsule (FC) formation of hepatocellular carcinoma (HCC).

Methods

Clinical data of 50 patients with HCC first diagnosed in the Third Affiliated Hospital of Sun Yat-sen University from December 2014 to October 2017 were retrospectively analyzed. Among them, 41 patients were male and 9 female, aged (49±10) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The HCC scirrhosity was determined by MRE and the FC was diagnosed by dynamic contrast-enhanced MRI (DCE-MRI). Pathological examination was taken as the gold standard of diagnosis. All the patients were divided into FC group (n=28) and non-FC group (n=22). The diagnostic accuracy of MRE for FC was evaluated. The HCC scirrhosity were statistically compared between two groups by t test. The diagnostic efficiency of MRE and DCE-MRI for FC was assessed by receiver operating characteristic (ROC) curve and diagnostic test.

Results

In FC group, the HCC scirrhosity measured by MRE was (4.6±1.1) kPa, significantly lower than (6.7±2.8) kPa in non-FC group (t=-2.853, P<0.05). The area under ROC curve of MRE in diagnosing FC was 0.737, the optimal diagnostic threshold was5.6 kPa, the sensitivity, specificity and diagnostic accuracy were 0.89, 0.68 and 0.74, respectively. The sensitivity, specificity and diagnostic accuracy of DCE-MRI in diagnosing FC were 0.93, 0.09 and 0.56, respectively.

Conclusions

The HCC scirrhosity measured by MRE can accurately diagnose the formation of FC. The diagnostic efficiency of MRE is better than that of DCE-MRI.

Key words: Carcinoma, hepatocellular, Fibrous capsule, Scirrhosity, Magnetic resonance elastography, Diagnosis

表1 FC组与无FC组肝癌患者一般资料比较

组别	例数	年龄（岁，±s ）	性别（例，男/女）	BMI（kg/m²，±s ）	肿瘤直径[mm，M（Q₂₅，Q₇₅）]	AFP[μg/L，M（Q₂₅，Q₇₅）]	组织分化程度（例）
组别	例数	年龄（岁，±s ）	性别（例，男/女）	BMI（kg/m²，±s ）	肿瘤直径[mm，M（Q₂₅，Q₇₅）]	AFP[μg/L，M（Q₂₅，Q₇₅）]	低	中	高
FC组	28	51±12	24/4	23±4	69（38，118）	25（5，879）0	8	13	7
无FC组	22	46±90	21/1	22±3	56（42，74）0	208（10，1 000）	10	9	3
统计值	?	t=1.757	χ²=1.406	t=0.878	U=1.988	U=0.999	?	χ²=1.856	?
P值	?	0.085	0.236	0.384	0.055	0.323	?	0.395	?

表1 FC组与无FC组肝癌患者一般资料比较

组别	例数	年龄（岁，±s ）	性别（例，男/女）	BMI（kg/m²，±s ）	肿瘤直径[mm，M（Q₂₅，Q₇₅）]	AFP[μg/L，M（Q₂₅，Q₇₅）]	组织分化程度（例）
组别	例数	年龄（岁，±s ）	性别（例，男/女）	BMI（kg/m²，±s ）	肿瘤直径[mm，M（Q₂₅，Q₇₅）]	AFP[μg/L，M（Q₂₅，Q₇₅）]	低	中	高
FC组	28	51±12	24/4	23±4	69（38，118）	25（5，879）0	8	13	7
无FC组	22	46±90	21/1	22±3	56（42，74）0	208（10，1 000）	10	9	3
统计值	?	t=1.757	χ²=1.406	t=0.878	U=1.988	U=0.999	?	χ²=1.856	?
P值	?	0.085	0.236	0.384	0.055	0.323	?	0.395	?

图1 一例肝癌患者MRE诊断纤维包膜形成情况

图2 MRE硬度值诊断FC的ROC曲线

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Diagnosing fibrous capsule formation of hepatocellular carcinoma by three-dimensional magnetic resonance elastography

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Diagnosing fibrous capsule formation of hepatocellular carcinoma by three-dimensional magnetic resonance elastography