MRI钆贝葡胺增强扫描在肝结节定性诊断及微血管侵犯评估中的应用

摘要/Abstract

摘要： 目的探究磁共振成像(MRI)钆贝葡胺(Gd-BOPTA)增强扫描在肝结节定性诊断及微血管侵犯评估中的应用。方法回顾性分析秦皇岛市第二医院2022年2月至2025年1月收治的337例肝结节患者的临床资料,所有患者均进行MRI Gd-BOPTA增强扫描,以病理检查为金标准,分析MRI Gd-BOPTA增强扫描对于肝结节良恶性的诊断效能。根据病理检查结果,将恶性结节患者按照微血管侵犯情况分为阳性组与阴性组,统计两组患者一般资料及MRI Gd-BOPTA增强扫描定性参数。采用多因素logistic回归分析探究微血管侵犯的影响因素,绘制受试者工作特征(ROC)曲线分析MRI Gd-BOPTA增强扫描对于微血管侵犯的预测效能。结果病理结果显示,337例患者中,良性结节266例,恶性结节71例;MRI Gd-BOPTA增强扫描结果显示,337例患者中,良性结节271例,恶性结节66例,MRI Gd-BOPTA增强扫描诊断肝结节性质的灵敏度、特异度、Kappa值分别为87.32%、98.50%、0.881。71例恶性肝结节患者中,24例(33.80%)患者存在微血管侵犯,47例(66.20%)患者无微血管侵犯情况。阳性组甲胎蛋白水平显著高于阴性组(P<0.05);两组瘤周强化、肿瘤边缘光整情况、肿瘤包膜及瘤周低信号比较差异具有统计学意义(P<0.05);多因素logistic回归分析结果显示:肿瘤边缘不光整、瘤周低信号为肝结节患者微血管侵犯的危险因素(P<0.05);ROC曲线分析结果显示,肿瘤边缘不光整、瘤周低信号预测肝结节微血管侵犯的曲线下面积(AUC)分别为0.642(95%CI:0.519~0.752)、0.791(95%CI:0.678~0.879),其中瘤周低信号预测肝结节微血管侵犯的AUC最高,灵敏度为62.50%、特异度为95.74%。结论 MRI Gd-BOPTA增强扫描在肝结节定性诊断中具有良好的临床应用价值,其定性参数中的肿瘤边缘不光整、瘤周低信号为肝结节患者微血管侵犯的危险因素,这些参数在预测肝结节微血管侵犯中具有良好的效能,值得在临床推广。

关键词: 肝结节, 磁共振成像增强扫描, 钆贝葡胺, 微血管侵犯, 定性诊断

Abstract: Objective To investigate the application of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) in qualitative diagnosis of liver nodules and assessment of microvascular invasion. Methods A retrospective analysis was conducted on the clinical data of 337 patients with liver nodules admitted to the Qinhuangdao Second Hospital from February 2022 to January 2025. All patients underwent Gd-BOPTA-enhanced MRI scan. Pathological examination was used as the gold standard to analyze the diagnostic efficacy of Gd-BOPTA-enhanced MRI scan for benign and malignant liver nodules. According to pathological results, patients with malignant nodules were divided into positive and negative groups according to the situation of microvascular invasion. General information of the two groups and qualitative parameters of Gd-BOPTA-enhanced MRI scan were statistically analyzed. Multivariate logistic regression analysis was used to explore the influencing factors of microvascular invasion, and the receiver operating characteristic (ROC) curve was plotted to analyze the predictive efficacy of Gd-BOPTA-enhanced MRI scan for microvascular invasion. Results Pathological results showed that among the 337 patients, there were 266 cases of benign nodules and 71 cases of malignant nodules. Gd-BOPTA-enhanced MRI scan revealed 271 cases of benign nodules and 66 cases of malignant nodules among the 337 patients. The sensitivity, specificity, and kappa value of Gd-BOPTA-enhanced MRI scan for diagnosing the nature of liver nodules were 87.32%, 98.50%, and 0.881, respectively. Among the 71 patients with malignant liver nodules, there were 24 (33.80%) patients with microvascular invasion, while 47 (66.20%) had no microvascular invasion. The level of alpha fetoprotein in the positive group was significantly higher than that in the negative group (P<0.05). There were significant differences between the two groups in terms of peritumoral enhancement, condition of tumor edge, tumor capsule, and peritumoral low signal (P<0.05). Multivariate logistic regression analysis found that irregular tumor edge and peritumoral low signal were risk factors for microvascular invasion in patients with liver nodules (P<0.05). ROC curve analysis results showed that the areas under the curve (AUCs) for predicting microvascular invasion of liver nodules with qualitative parameters of irregular tumor edge and peritumoral low signal were 0.642 (95%CI: 0.519~0.752) and 0.791 (95%CI: 0.678~0.879), respectively. In addition, the AUC of peritumoral low signal was greater, with a sensitivity of 62.50% and a specificity of 95.74%. Conclusion Gd-BOPTA-enhanced MRI scan has good application value in qualitative diagnosis of liver nodules. Its qualitative parameters, including irregular tumor edge and peritumoral low signal, are risk factors for microvascular invasion in patients with liver nodules, and demonstrate good efficacy in predicting microvascular invasion of liver nodules.

Key words: Liver nodule, Enhanced magnetic resonance imaging scan, Gadobenate dimeglumine, Microvascular invasion, Qualitative diagnosis

刘勇, 杨愈佳, 张状, 徐淑静. MRI钆贝葡胺增强扫描在肝结节定性诊断及微血管侵犯评估中的应用[J]. 肝脏, 2026, 31(7): 1004-1009.

Liu Yong, Yang Yujia, Zhang Zhuang, Xu Shujing. Application of Gd-BOPTA-enhanced MRI in qualitative diagnosis of liver nodules and assessment of microvascular invasion[J]. Chinese Hepatolgy, 2026, 31(7): 1004-1009.

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