DCE-MRI参数评估原发性肝癌患者肿瘤病理分级的效能及意义

摘要/Abstract

摘要： 目的研究动态增强磁共振扫描(DCE-MRI)参数评估原发性肝癌(PLC)患者肿瘤病理分级的效能及意义。方法选择2020年6月至2023年6月本院收治的80例PLC患者作为观察组,50例肝脏良性结节患者作为对照组。采用Edmondson-Steiner′s肿瘤病理分级法对观察组患者进行评估,Ⅰ级纳入轻度组(24例),Ⅱ～Ⅲ级纳入中度组(30例),Ⅳ级纳入重度组(26例)。所有患者均接受DCE-MRI检查,记录血管外细胞外体积(V_e)、血浆容积分数(V_p)、转移常数(K^trans)、流出速率(K_ep)。绘制受试者工作特征(ROC)曲线,分析DCE-MRI参数诊断中重度PLC的价值。结果观察组V_e、V_p、K^trans、K_ep值高于对照组(均P<0.05),分别为(0.75±0.24)、(0.41±0.09)、(1.04±0.31)、(2.74±0.49),对照组V_e、V_p、K^trans、K_ep值分别为(0.43±0.12)、(0.24±0.07)、(0.63±0.17)、(1.58±0.34);轻度组V_e、V_p、K^trans、K_ep值分别为(0.53±0.17)、(0.27±0.07)、(0.84±0.19)、(1.93±0.45),中度组分别为(0.68±0.22)、(0.39±0.12)、(0.97±0.23)、(2.51±0.72),重度组分别为(0.91±0.29)、(0.51±0.16)、(1.15±0.29)、(3.18±0.85),轻度组的V_e、V_p、K^trans、K_ep值低于中度组和重度组,中度组的V_e、V_p、K^trans、K_ep值低于重度组(P<0.05)。ROC曲线分析显示,V_e、V_p、K^trans、K_ep值诊断中重度PLC的AUC分别为0.905(95%CI:0.846～0.964)、0.751(95%CI:0.639～0.830)、0.772(95%CI:0.674～0.870)、0.916(95%CI:0.871～0.961)。结论不同病理分级的PLC患者的DCE-MRI定量参数均存在一定差异,并且病理分级越高,其V_e、V_p、K^trans、K_ep值越大,临床可依据V_e、V_p、K^trans、K_ep等指标对患者的病理分级进行评估,效能较好。

关键词: 原发性肝癌, 动态增强磁共振扫描, 定量参数, 肿瘤病理分级, 诊断效能

Abstract: Objective To study the efficacy and significance of dynamic enhanced magnetic resonance imaging (DCE-MRI) parameters in evaluating the pathological grading of primary liver cancer (PLC) patients. Methods Eighty PLC patients admitted to our hospital from June 2020 to June 2023 were selected as the observation group and 50 patients with hepatic benign nodules were selected as the control group. Edmondson-Steiner's tumor pathological grading method was used to evaluate the patients in the observation group, and 24 cases of grade Ⅰ were included in the mild group, 30 cases of grade Ⅱ to Ⅲ were included in the moderate group, and 26 cases of grade Ⅳ were included in the severe group. All patients underwent DCE-MRI, and their extracellular volume (V_e), plasma volume fraction (V_p), transfer constant (K^trans), and outflow rate (K_ep) were recorded. Receiver operating characteristic (ROC) curves were used to analyze the value of DCE-MRI parameters in diagnosing severe PLC. Results The values of V_e, V_p, K^trans and K_ep in the observation group were (0.75±0.24), (0.41±0.09), (1.04±0.31) and (2.74±0.49), respectively. The values of V_e, V_p, K^trans and Kep in control group were (0.43±0.12), (0.24±0.07), (0.63±0.17) and (1.58±0.34), respectively. The values of V_e, V_p, K^trans and K_ep in observation group were higher than those in control group (P<0.05). The values of V_e, V_p, K^trans and K_ep in mild group were (0.53±0.17), (0.27±0.07), (0.84±0.19) and (1.93±0.45), respectively. The values of V_e, V_p, K^trans and K_ep in the moderate group were (0.68±0.22), (0.39±0.12), (0.97±0.23) and (2.51±0.72), respectively. The values of V_e, V_p, K^trans and K_ep in the severe group were (0.91±0.29), (0.51±0.16), (1.15±0.29) and (3.18±0.85), respectively. The values of V_e, V_p, K^trans and K_ep in the mild group were lower than those in the moderate and severe groups. The V_e, V_p, K^trans and K_ep values in moderate group were lower than those in severe group (P<0.05). ROC analysis showed that the area under the curve (AUC) value of the V_e, V_p, K^trans, and K_ep for diagnosing the moderate to severe PLC were 0.905 (95% CI: 0.846~0.964), 0.751 (95% CI: 0.639~0.830), 0.772 (95% CI: 0.674~0.870), and 0.916 (95% CI: 0.871~0.961), respectively. Conclusion The quantitative parameters in DCE-MRI of PLC patients with different pathological grades are different to some extent, and the higher the pathological grade is, the higher the V_e, V_p, K^trans, K_ep values are. Clinically, the pathological grading of patients can be evaluated based on indicators such as V_e, V_p, K^trans, K_ep, etc., with good efficacy.

Key words: Primary liver cancer, Dynamic enhanced magnetic resonance scanning, Quantitative parameters, Tumor pathological grade, Diagnostic efficiency

赵言, 李文华, 曾旭, 王旭昇. DCE-MRI参数评估原发性肝癌患者肿瘤病理分级的效能及意义[J]. 肝脏, 2025, 30(11): 1503-1506.

ZHAO Yan, LI Wen-hua, ZENG Xu, WANG Xu-sheng. Efficacy and significance of DCE-MRI parameters in evaluating tumor pathological grading in patients with primary liver cancer[J]. Chinese Hepatolgy, 2025, 30(11): 1503-1506.

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