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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 285 -289. doi: 10.3877/cma.j.issn.2095-3232.2021.03.011

所属专题： 文献；

临床研究

MRI征象对LI-RADS 5分肝癌微血管浸润及术后早期复发的预测价值
肖远强1, 李梦思1, 邝思驰1, 张林启1, 朱婕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:2021-03-19 出版日期:2021-06-10
  • 通信作者: 王劲
  • 基金资助:
    国家自然科学基金重大研究计划培育项目(91959118); 中华国际医学会交流基金会SKY影像科研基金项目(Z-2014-07-1912-15)

Predictive value of MRI signs for microvascular invasion and postoperative early recurrence in patients with LI-RADS 5 hepatocellular carcinoma

Yuanqiang Xiao1, Mengsi Li1, Sichi Kuang1, Linqi Zhang1, Jie Zhu1, Jin Wang1,†()   

  1. 1. Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2021-03-19 Published:2021-06-10
  • Corresponding author: Jin Wang
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引用本文：

肖远强, 李梦思, 邝思驰, 张林启, 朱婕, 王劲. MRI征象对LI-RADS 5分肝癌微血管浸润及术后早期复发的预测价值[J]. 中华肝脏外科手术学电子杂志, 2021, 10(03): 285-289.

Yuanqiang Xiao, Mengsi Li, Sichi Kuang, Linqi Zhang, Jie Zhu, Jin Wang. Predictive value of MRI signs for microvascular invasion and postoperative early recurrence in patients with LI-RADS 5 hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(03): 285-289.

目的

探讨MRI征象对肝脏影像报告和数据系统（LI-RADS）5分的单发肝细胞癌（肝癌）患者微血管浸润（MVI）及术后早期复发的预测价值。

方法

回顾性分析2014年3月至2018年10月中山大学附属第三医院收治的211例肝癌肝切除术患者临床资料。其中男158例，女53例；年龄31～78岁，中位年龄47岁。所有患者术前1个月内行3.0-T动态增强MRI检查，均为LI-RADS 5分（LR-5）的单发肝癌。根据组织病理学检查结果评估MVI，术后通过临床及影像学随访明确肿瘤早期复发。采用Logistic回归分析与术后早期复发相关的临床和影像学独立预测因子。

结果

211例肝癌切除患者中，57例病理证实MVI，49例术后肿瘤早期复发。多因素Logistic回归分析显示，马赛克征是肝癌MVI的独立预测因素（OR=2.308，95%CI:1.166～4.569，P<0.05）；晕征是肝切除术后肝癌早期复发的独立预测因素（OR=2.447，95%CI:1.213～4.939，P<0.05）。

结论

对于LR-5单发肝癌患者，动态MRI的马赛克征和晕征可预测肝癌MVI和肝切除术后早期复发。

关键词: 癌, 肝细胞, 磁共振成像, 微血管浸润, 复发, 预测
Objective

To evaluate the predictive value of MRI sings for the microvascular invasion (MVI) and postoperative early recurrence in patients with single hepatocellular carcinoma (HCC) classified as Liver Imaging Reporting and Data System (LI-RADS) 5.

Methods

Clinical data of 211 HCC patients undergoing hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University from March 2014 to October 2018 were retrospectively analyzed. Among them, 158 patients were male and 53 female, aged from 31 to 78 years with a median age of 47 years. All patients received 3.0-T dynamic contrast-enhanced MRI examination within 1 month before operation, and all of them were diagnosed with single HCC classified as LI-RADS 5 (LR-5). MVI was evaluated according to the histopathological examination result. Early recurrence of HCC was confirmed by clinical and imaging follow-up. The independent clinical and imaging predictors for postoperative recurrence were analyzed by Logistic regression analysis.

Results

Among 211 patients undergoing hepatectomy, 57 cases were pathologically diagnosed with MVI and 49 cases developed postoperative early recurrence. Multivariate Logistic regression analysis revealed that mosaic sign was an independent predictor for MVI in HCC patients (OR=2.308, 95%CI: 1.166-4.569, P<0.05). Halo sign was an independent predictor for early recurrence of HCC after hepatectomy (OR=2.447, 95%CI:1.213-4.939, P<0.05).

Conclusion

Mosaic and halo signs of dynamic MRI can predict MVI and early recurrence after hepatectomy in patients with single HCC classified as LR-5.

Key words: Carcinoma, hepatocellular, Magnetic resonance imaging, Microvascular invasion, Recurrence, Forecasting
表1 肝癌微血管浸润预测因素的Logistic回归分析
因素 单因素分析 多因素分析
  OR 95%CI P值 OR 95%CI P值
AFP>400 μg/L 2.250 1.133～4.469 0.021 1.954 0.955～4.000 0.067
马赛克征 2.770 1.434～5.352 0.002 2.308 1.166～4.569 0.016
晕征 1.906 0.971～3.742 0.031 1.688 0.822～3.385 0.156
弥散受限 2.667 0.321～22.167 0.364      
不规则肿瘤边缘 1.929 1.037～3.588 0.038 1.465 0.758～2.830 0.256
表2 肝癌术后早期复发预测因素的Logistic回归分析
因素 单因素分析 多因素分析
  OR 95%CI P值 OR 95%CI P值
AFP>400 μg/L 0.866 0.395～1.900 0.720      
马赛克征 1.281 0.670～2.449 0.043 1.070 0.541～2.115 0.846
晕征 2.537 1.287～5.144 0.007 2.447 1.213～4.939 0.012
弥散受限 0.904 0.177～4.628 0.903      
不规则肿瘤边缘 1.630 0.850～3.124 0.048 1.483 0.751～2.929 0.257
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