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    MRI增强扫描对原发性肝癌患者肝动脉化疗栓塞术后MVI预后的预测价值

    The value of enhanced MRI scanning in predicting the prognosis of MVI after transcatheter arterial chemoembolization in patients with primary hepatocellular carcinoma

      摘要
    • 摘要: 目的：探究磁共振成像（MRI）增强扫描预测原发性肝癌（PHC）患者肝动脉化疗栓塞术（TACE）后微血管侵犯（MVI）预后的价值。方法：选取2020年1月至2022年1月四川省南充市中心医院收治的100例TACE后合并MVI的PHC患者，均行MRI增强扫描获取定量参数肝动脉灌注指数（HPI）、容积转移常数（Ktrans）；统计术后1年内复发情况，根据术后1年是否复发分为复发组和未复发组，比较两组临床资料、血清肿瘤标志物癌胚抗原（CEA）、甲胎蛋白（AFP）、MRI影像学特征及定量参数，通过logistic回归模型分析预后影响因素，通过ROC曲线分析MRI定量参数预测复发的价值，进一步通过ROC曲线下面积（AUC）、净重新分类指数（NRI）、综合判别改善指数（IDI）评价含与不含MRI定量参数预测方案的预测效果。结果：完成术后1年随访的98例患者中复发率为45.92%（45/98）；复发组肿瘤数目、瘤内坏死、肿瘤直径之比、血清CEA、AFP水平与未复发组比较差异明显（P<0.05）；复发与未复发患者MRI影像学特征相近，但复发组HPI、Ktrans高于未复发组（P<0.05）；肿瘤数目、瘤内坏死、肿瘤直径之比、血清CEA、AFP、HPI、Ktrans均为术后复发的影响因素（P<0.05）；HPI、Ktrans联合预测复发的AUC为0.862，大于二者单独预测（P<0.05）。含与不含MRI定量参数预测方案的AUC（0.930 vs.0.815）比较差异明显（P<0.05）。NRI、IDI分析显示，含MRI定量参数预测方案的预测效果较不含MRI定量参数预测方案有明显改善（P<0.05）。结论：TACE术后合并MVI的PHC患者术后复发受肿瘤数目、瘤内坏死、肿瘤直径之比、血清CEA、AFP、HPI、Ktrans等因素影响，含MRI定量参数HPI、Ktrans预测方案对术后复发的预测价值较高。

       

      Abstract: Objective:To explore the prognostic value of enhanced magnetic resonance imaging (MRI) scanning in predicting the prognosis of microvascular invasion (MVI) after transcatheter arterial chemoembolization(TACE) in patients with primary hepatocellular carcinoma (PHC).Methods:A total of 100 PHC patients with MVI after TACE admitted to Nanchong Central Hospital of Sichuan Province from January 2020 to January 2022were selected, and quantitative parametershepatic artery perfusion index (HPI), volume transfer constant (Ktrans)were obtained by MRI enhanced scanning.The incidence of recurrence within 1 year after surgery was analyzed.The patients were divided into recurrence group and non-recurrence group according to whether recurrence occurred within 1 year after surgery.Clinical data, serum tumor markerscarcinoembryonic antigen (CEA), alphafetoprotein (AFP), MRI imaging characteristics and quantitative parameters of the two groups were compared, and prognostic factors were analyzed by logistic regression model.The receiver operating characteristic (ROC) curve was used to analyze the value of MRI quantitative parameters in predicting recurrence, and the area under the ROC curve (AUC), net reclassification index (NRI) as well as comprehensive discriminant improvement index (IDI) were used to evaluate the prediction effect of prediction schemes with and without MRI quantitative parameters.Results:The recurrence rate of 98 patients was 45.92%(45/98) after 1 year follow-up.There were significant differences in tumor number, intratumoral necrosis, tumor diameter ratio, serum CEA and AFP levels between the recurrence group and the non-recurrence group (P<0.05).MRI imaging features of patients with and without recurrence were similar, but HPI and Ktransin the recurrence group were higher than those in the non-recurrence group (P<0.05).Tumor number, intratumbral necrosis, tumor diameter ratio, serum CEA, AFP, HPI and Ktranswere all influencing factors for postoperative recurrence (P<0.05).The AUC predicted by HPI and Ktranswas 0.862, which was higher than that predicted by HPI and Ktransalone (P<0.05).The AUC with and without MRI quantitative parameter prediction scheme (0.930 vs.0.815) was significantly different (P<0.05).NRI and IDI analysis showed that the prediction effect of the prediction scheme with MRI quantitative parameters was significantly improved compared with that without MRI quantitative parameters (P<0.05).Conclusion:Postoperative recurrence of PHC patients with MVI after TACE surgery is affected by the tumor number, intratumbral necrosis, tumor diameter ratio, serum CEA, AFP, HPI, Ktransand other factors.The prediction scheme including MRI quantitative parameters HPI and Ktranshas a high value in predicting postoperative recurrence.

       

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