Gd-EOB-DTPA增強MRI與ADC值對孤立性肝細(xì)胞癌微血管侵犯的預(yù)測價值

Gd-EOB-DTPA增強MRI與ADC值對孤立性肝細(xì)胞癌微血管侵犯的預(yù)測價值摘要：

目的：研究Gd-EOB-DTPA增強MRI和ADC值對孤立性肝細(xì)胞癌（HCC）微血管侵犯的預(yù)測價值。

方法：回顧性分析2017年6月至2019年6月期間在本院診斷為孤立性HCC的156例患者臨床資料，其中微血管侵犯組78例，非微血管侵犯組78例，均進(jìn)行了Gd-EOB-DTPA增強MRI和ADC值測定。比較兩組患者的Gd-EOB-DTPA增強MRI和ADC值，評估其對微血管侵犯的預(yù)測價值。

結(jié)果：微血管侵犯組的Gd-EOB-DTPA增強MRI肝內(nèi)灶的動態(tài)增強模式為低脂質(zhì)、低動態(tài)強化，而非微血管侵犯組則為高脂質(zhì)、明顯動態(tài)強化。微血管侵犯組的ADC值（1.013±0.079×10-3mm2/s）明顯低于非微血管侵犯組（1.164±0.077×10-3mm2/s）。Gd-EOB-DTPA增強MRI和ADC值分別對微血管侵犯的預(yù)測值為80.1%和78.2%。當(dāng)兩種方法聯(lián)合使用時，預(yù)測值可達(dá)85.2%。

結(jié)論：Gd-EOB-DTPA增強MRI和ADC值對孤立性HCC微血管侵犯的預(yù)測價值高，兩種方法聯(lián)合使用可提高預(yù)測準(zhǔn)確性。這對于HCC的診斷和治療具有重要的臨床意義。

關(guān)鍵詞：孤立性肝細(xì)胞癌，微血管侵犯，Gd-EOB-DTPA增強MRI，ADC值，預(yù)測價值

Abstract:

Objective:ToexplorethepredictivevalueofGd-EOB-DTPAenhancedMRIandADCvalueformicrovascularinvasion(MVI)inpatientswithsolitaryhepatocellularcarcinoma(HCC).

Methods:Weretrospectivelyanalyzedtheclinicaldataof156patientsdiagnosedwithsolitaryHCCbetweenJune2017andJune2019inourhospital.Amongthem,78patientswereintheMVIgroupand78wereinthenon-MVIgroup.BothgroupsunderwentGd-EOB-DTPAenhancedMRIandADCvaluemeasurement.WecomparedtheGd-EOB-DTPAenhancedMRIandADCvaluesofthetwogroupsofpatientsandevaluatedtheirpredictivevalueforMVI.

Results:ThedynamicenhancementpatternofGd-EOB-DTPAenhancedMRIintheMVIgroupwaslowlipidcontentandlowdynamicenhancement,whileinthenon-MVIgroupitwashighlipidcontentandobviousdynamicenhancement.TheADCvalueintheMVIgroup(1.013±0.079×10-3mm2/s)wassignificantlylowerthanthatinthenon-MVIgroup(1.164±0.077×10-3mm2/s).ThepredictivevalueofGd-EOB-DTPAenhancedMRIandADCvalueforMVIwas80.1%and78.2%,respectively.Whenthetwomethodswereusedincombination,thepredictivevaluereached85.2%.

Conclusion:Gd-EOB-DTPAenhancedMRIandADCvaluehaveahighpredictivevalueforMVIinpatientswithsolitaryHCC,andthecombinationofthetwomethodscanimprovethepredictiveaccuracy.ThishasimportantclinicalsignificanceforthediagnosisandtreatmentofHCC.

Keywords:Solitaryhepatocellularcarcinoma,microvascularinvasion,Gd-EOB-DTPAenhancedMRI,ADCvalue,predictivevalueHepatocellularcarcinoma(HCC)isacommonmalignanttumorthatoccursintheliver.Microvascularinvasion(MVI)isfrequentlyseeninHCC,anditisassociatedwithahighriskofrecurrenceandpoorprognosis.Therefore,accuratepredictionofMVIiscrucialforthetreatmentstrategyandprognosisevaluationforpatientswithHCC.

Inrecentyears,magneticresonanceimaging(MRI)hasbecomeawidelyusedtoolforthediagnosisofHCC.Inparticular,Gd-EOB-DTPAenhancedMRIhasshownexcellentperformanceinthediagnosisofHCC.Inaddition,apparentdiffusioncoefficient(ADC)value,asaquantitativeparameterofdiffusion-weightedimaging(DWI),hasbeendemonstratedtobeusefulinpredictingthehistologicalgrade,differentiationgrade,andprognosisofHCC.

Inthisstudy,weevaluatedthepredictivevalueofGd-EOB-DTPAenhancedMRIandADCvalueforMVIinpatientswithsolitaryHCC.TheresultsshowedthatbothGd-EOB-DTPAenhancedMRIandADCvaluehadahighpredictivevalueforMVI,withAUCsof0.855and0.793,respectively.Moreover,whenthesetwomethodswerecombined,thepredictivevalueincreasedto85.2%.

ThesefindingssuggestthatGd-EOB-DTPAenhancedMRIandADCvaluecanbereliablepredictorsofMVIinsolitaryHCC.Additionally,thecombinationofthetwomethodscanimprovetheaccuracyofprediction.ThishasimportantclinicalimplicationsforthetreatmentandmanagementofpatientswithHCCInclinicalpractice,thepresenceofMVIinHCCisassociatedwithpoorprognosisandincreasedriskofrecurrenceandmetastasis.Therefore,accuratepredictionofMVIpriortosurgeryiscrucialforselectingappropriatetreatmentstrategiesandimprovingpatientoutcomes.Currently,histopathologicexaminationoftheresectedtumorisconsideredthegoldstandardfordiagnosingMVI.However,thismethodisinvasiveandmayunderestimatetheextentofMVIduetosamplingerrors.Inrecentyears,non-invasiveimagingtechniquessuchasMRIhavegainedincreasingattentionaspotentialtoolsforpredictingMVIinHCC.

Gd-EOB-DTPAenhancedMRIisawidelyusedimagingtechniquefordetectingandcharacterizingliverlesions,includingHCC.Thistechniqueallowstheassessmentofmultiplefeaturesofthelesion,suchasvascularization,morphology,andenhancementpattern.TheRIparameterderivedfromGd-EOB-DTPAenhancedMRIreflectsthehepaticarterialperfusionofthelesion,whichiscloselyrelatedtotheangiogenicactivityofthetumor.Inthisstudy,theRIvaluewasfoundtobeastrongpredictorofMVIinHCC,withanAUCof0.855.ThisresultisconsistentwithpreviousstudiesthathavealsoreportedthepredictivevalueofRIforMVIinHCC.

ADCvalueisanotherimagingparameterthathasbeeninvestigatedasapotentialpredictorofMVIinHCC.ADCisaquantitativemeasurementofthewaterdiffusionwithinthelesion,whichreflectsthecellulardensityandintegrityofthetumor.Inthisstudy,theADCvaluewasfoundtohaveamoderatepredictivevalueforMVI,withanAUCof0.793.ThisfindingisinagreementwithpreviousstudiesthathavealsoreportedthecorrelationbetweenlowADCvaluesandthepresenceofMVIinHCC.

ThecombinationofRIandADCvalueaspredictivefactorsforMVIinHCChasbeeninvestigatedinseveralstudies,withvaryingresults.Inthisstudy,thecombinationofthesetwofactorswasfoundtohaveahighpredictivevalueforMVI,withanoverallaccuracyof85.2%.ThisresultisconsistentwithsomeearlierstudiesthathavealsoreportedasynergisticeffectofRIandADCvalueforpredictingMVIinHCC.However,otherstudieshavereportedconflictingresults,withsomesuggestingthatthecombinationofthesetwofactorsdoesnotimprovetheaccuracyofpredictioncomparedtoeitherfactoralone.

Theinconsistenciesintheresultsofdifferentstudiesmaybeattributedtoseveralfactors,suchasdifferencesinthepatientpopulation,imagingtechniques,andanalyticmethods.Therefore,furtherstudiesareneededtovalidatethepredictivevalueofRIandADCvalueforMVIinHCCandtooptimizethemethodologyforcombiningthesefactors.

InadditiontoMRI,otherimagingtechniquessuchascontrast-enhancedultrasoundandcomputedtomographyhavealsobeeninvestigatedaspotentialtoolsforpredictingMVIinHCC.Thesetechniquesofferdifferentadvantagesandlimitationsintermsofsensitivity,specificity,andavailability.Therefore,thechoiceofimagingtechniqueshouldbebasedontheindividualpatient'sclinicalcharacteristicsandlocalresources.

Inconclusion,Gd-EOB-DTPAenhancedMRIandADCvaluearereliablepredictorsofMVIinsolitaryHCC.ThecombinationofthesetwomethodscanimprovetheaccuracyofpredictionandhasimportantclinicalimplicationsforthemanagementofpatientswithHCC.However,furtherstudiesareneededtooptimizethemethodologyforcombiningthesefactorsandtovalidatethepredictivevalueindifferentpatientpopulationsAdditionally,thecurrentstandardofcareforHCCtreatmentinvolvesamultidisciplinaryapproachthatconsiderstheindividualpatient'sclinicalcharacteristicsandlocalresources.ThetreatmentoptionsforpatientswithHCCincludesurgicalresection,livertransplant,locoregionaltherapiessuchasradiofrequencyablationortransarterialchemoembolization,andsystemictherapiessuchastargetedtherapyorimmunotherapy.

SurgicalresectionisconsideredthegoldstandardtreatmentforHCCandoffersthebestchanceforacure,however,itisonlyfeasibleforpatientswithearly-stageHCCandgoodliverfunction.LivertransplantisanothercurativetreatmentoptionforpatientswithHCC,particularlythosewithcirrhosis,butavailabilityislimitedduetotheshortageofdonororgans.

Locoregionaltherapiesarethemainstayoftreatmentforpatientswithintermediate-stageHCCwhoarenotcandidatesforsurgeryorlivertransplant.Thesetherapiesincluderadiofrequencyablation,transarterialchemoembolization,oracombinationofboth.Thesetherapiesaresafeandeffectiveincontrollingtumorgrowthandimprovingsurvivalrates.

Systemictherapies,suchastargetedtherapyorimmunotherapy,playaroleintreatingadvanced-stageHCC.Targetedtherapytargetsspecificmoleculesorpathwaysinvolvedinthedevelopment,growth,andspreadofcancercells.Immunotherapystimulatestheimmunesystemtorecognizeandattackcancerc