乙型肝炎背景下肝细胞癌钆塞酸二钠增强MRI与组织学 分化程度相关性分析

doi:10.19871/j.cnki.xfcrbzz.2022.04.011

摘要/Abstract

摘要： 目的回顾性分析钆塞酸二钠（Gd-EOB-DTPA）增强MRI各期信号定量指标与肝细胞癌（HCC）分化程度的相关性。方法收集2020年6月至2021年6月首都医科大学附属北京地坛医院病理证实为乙型病毒性肝炎背景下38例HCC患者的临床及病理资料,分为高分化（10例）,中分化（21例）,低分化（7例）三组。Gd-EOB-DTPA增强MRI检查,计算平扫及增强各期肝实质信号噪声比（SNR）、肿瘤与肝实质对比率（LLC）、肿瘤对比增强率（CER）及肿瘤与肝实质信号强度比（SIR）,比较不同分化程度HCC各期信号定量指标差异。结果 38例患者中,7例低分化HCC、21例中分化HCC、10例高分化HCC。平扫及动脉期肝实质SNR均低于门脉期及肝胆期（P<0.05）。高分化HCC平扫及肝胆期LLC值高于中分化HCC;高分化HCC动脉期CER值低于中、低分化HCC;高分化HCC平扫SIR高于中、低分化HCC,高分化HCC肝胆期SIR高于中分化HCC,差异均具有统计学意义（P<0.05）。高分化HCC T₁WI呈等信号及强化方式不典型比例较高。结论 Gd-EOB-DTPA增强MRI定量指标LLC、CER及SIR均与HCC组织学分化程度相关,对不同分化程度HCC的评估有一定价值。

关键词: 乙型病毒性肝炎, 肝细胞癌, 分化程度, 钆塞酸二钠, 磁共振成像

Abstract: Objective A retrospective analysis was performed to analyze the the correlation between quantitative indicators by gadoxetic acid disodium enhanced MRI and the differentiation degree of hepatocellular carcinoma. Method A total of 38 patients who pathologically confirmed for HCC in hepatitis B which were divided into high(10 patients), medium(21 patients) and low(7 patients) groups at our institution between June 2020 and June 2021 were retrospectively analyzed. Gadoxetic acid enhanced MRI was performed in all patients before surgery. The SNR of liver parenchyma, LLC, CER and SIR of HCC were calculated. The comparisons of these quantitative data among different grades were performed. Result Among 38 patients, 7 were poorly differentiated, 21 were moderately differentiated and 10 were well differentiated. The SNR of hepatic parenchymal in plain scan and arterial phase (AP) were lower than those in portal venous phase (PVP) and hepatobiliary phase (HP) (P<0.05). The LLC value of well differentiated HCC was higher than moderately differentiated HCC in plain scan and HP; the CER value of well differentiated HCC was lower than moderately and poorly differentiated HCC in AP; The value of SIR of well differentiated HCC was higher than moderately and poorly differentiated HCC in plain scan, and well differentiated was higher than moderately differentiated in HP; all the differences were statistically significant (P<0.05). Conclusion The quantitative index LLC, CER and SI ratios of Gd-EOB-DTPA-enhanced MRI were correlated with the histological differentiation of hepatocellular carcinoma, which could provided value for the evaluation of hepatocellular carcinoma with different degrees.

Key words: Hepatitis B, Hepatocellular carcinoma, Histological grade, Gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid, Magnetic resonance imaging

杜艳妮, 吕志彬, 邢玉雪, 关春爽, 张紫欣, 谢汝明, 陈步东. 乙型肝炎背景下肝细胞癌钆塞酸二钠增强MRI与组织学分化程度相关性分析[J]. 新发传染病电子杂志, 2022, 7(4): 47-52.

Du Yanni, Lyu Zhibin, Xing Yuxue, Guan Chunshuang, Zhang Zixin, Xie Ruming, Chen Budong. Correlation between Gd-EOB-DTPA enhanced MRI and histologic grade of hepatocellular carcinoma in hepatitis B[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(4): 47-52.

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