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中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 252 -255. doi: 10.3877/cma.j.issn.2095-3232.2019.03.017

所属专题: 文献

临床研究

三维磁共振弹性成像诊断肝癌纤维包膜形成
杨浩1, 陈景标1, 张瑶1, 肖远强1, 邝思驰1, 王劲1,()   
  1. 1. 510630 广州,中山大学附属第三医院放射科
  • 收稿日期:2019-03-08 出版日期:2019-06-10
  • 通信作者: 王劲
  • 基金资助:
    国家自然基金面上项目(81271562); 广州市产学研协同创新重大专项民生科技研究(201704020016)

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

Hao Yang1, Jingbiao Chen1, Yao Zhang1, Yuangqiang Xiao1, Sichi Kuang1, Jin Wang1,()   

  1. 1. Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2019-03-08 Published:2019-06-10
  • Corresponding author: Jin Wang
  • About author:
    Corresponding author: Wang Jin, Email:
引用本文:

杨浩, 陈景标, 张瑶, 肖远强, 邝思驰, 王劲. 三维磁共振弹性成像诊断肝癌纤维包膜形成[J/OL]. 中华肝脏外科手术学电子杂志, 2019, 08(03): 252-255.

Hao Yang, Jingbiao Chen, Yao Zhang, Yuangqiang Xiao, Sichi Kuang, Jin Wang. Diagnosing fibrous capsule formation of hepatocellular carcinoma by three-dimensional magnetic resonance elastography[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(03): 252-255.

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。

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.

表1 FC组与无FC组肝癌患者一般资料比较
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
[1]
Ishizaki M,Ashida K,Higashi T, et al. The formation of capsule and septum in human hepatocellular carcinoma[J]. Virchows Arch, 2001, 438(6):574-580.
[2]
Tang A,Bashir MR,Corwin MT, et al. Evidence supporting LI-RADS major features for CT- and MR imaging-based diagnosis of hepatocellular carcinoma: a systematic review[J]. Radiology, 2018, 286(1):29-48.
[3]
Kulik L,El-Serag HB. Epidemiology and management of hepatocellular carcinoma[J]. Gastroenterology, 2019, 156(2):477-491, e1.
[4]
Yantong Y,Shan L,Zhijie C, et al. A model prediction of long-term prognosis in patients with centrally located hepatocellular carcinoma undergoing hepatectomy[J]. Eur J Surg Oncol, 2018, 44(10):1595-1602.
[5]
Lee EC,Kim SH,Park H, et al. Survival analysis after liver resection for hepatocellular carcinoma: a consecutive cohort of 1002 patients[J]. J Gastroenterol Hepatol, 2017, 32(5):1055-1063.
[6]
Wakasa K,Sakurai M,Kuroda C, et al. Effect of transcatheter arterial embolization on the boundary architecture of hepatocellular carcinoma[J]. Cancer, 1990, 65(4):913-919.
[7]
Nagasue N,Uchida M,Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma[J]. Gastroenterology, 1993, 105(2):488-494.
[8]
Channual S,Pahwa A,Lu DS, et al. Enhancements in hepatobiliary imaging: the spectrum of gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid usages in hepatobiliary magnetic resonance imaging[J]. Abdom Radiol, 2016, 41(9):1825-1841.
[9]
Ishigami K,Yoshimitsu K,Nishihara Y, et al. Hepatocellular carcinoma with a pseudocapsule on gadolinium-enhanced MR images: correlation with histopathologic findings[J]. Radiology, 2009, 250(2):435-443.
[10]
Nakayama H,Enzan H,Yamamoto M, et al. High molecular weight caldesmon positive stromal cells in the capsule of hepatocellular carcinomas[J]. J Clin Pathol, 2004, 57(7):776-777.
[11]
Hoodeshenas S,Yin M,Venkatesh SK. Magnetic resonance elastography of liver: current update[J]. Top Magn Reson Imaging, 2018, 27(5):319-333.
[12]
Imajo K,Kessoku T,Honda Y, et al. Magnetic resonance imaging more accurately classifies steatosis and fibrosis in patients with nonalcoholic fatty liver disease than transient elastography[J]. Gastroenterology, 2016, 150(3):626-637, e7.
[13]
Morisaka H,Motosugi U,Ichikawa S, et al. Magnetic resonance elastography is as accurate as liver biopsy for liver fibrosis staging[J]. J Magn Reson Imaging, 2018, 47(5):1268-1275.
[14]
Thompson SM,Wang J,Chandan VS, et al. MR elastography of hepatocellular carcinoma: correlation of tumor stiffness with histopathology features-preliminary findings[J]. Magn Reson Imaging, 2017(37):41-45.
[15]
Venkatesh SK,Yin M,Ehman RL. Magnetic resonance elastography of liver: technique, analysis, and clinical applications[J]. J Magn Reson Imaging, 2013, 37(3):544-555.
[16]
Bridle KR,Crawford DH,Powell LW, et al. Role of myofibroblasts in tumour encapsulation of hepatocellular carcinoma in haemochromatosis[J]. Liver, 2001, 21(2):96-104.
[17]
Ooi LP,Crawford DH,Gotley DC, et al. Evidence that "myofibroblast-like" cells are the cellular source of capsular collagen in hepatocellular carcinoma[J]. J Hepatol, 1997, 26(4):798-807.
[18]
Ohashi M,Wakai T,Korita PV, et al. Histological evaluation of intracapsular venous invasion for discrimination between portal and hepatic venous invasion in hepatocellular carcinoma[J]. J Gastroenterol Hepatol, 2010, 25(1):143-149.
[19]
Ueda K,Matsui O,Kawamori Y, et al. Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography[J]. Radiology, 1998, 206(1):161-166.
[20]
Wang J,Shan Q,Liu Y, et al. 3D MR elastography of hepatocellular carcinomas as a potential biomarker for predicting tumor recurrence[J]. J Magn Reson Imaging, 2019, 49(3):719-730.
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