The value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI in the prediction of microvascular invasion of hepatocellular carcinoma / 中华放射学杂志

ABSTRACT

Objective To investigate the predictive value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI for microvascular invision (MVI) in hepatocellular carcinoma (HCC). Methods Retrospective analysis of 70 patients confirmed by pathology as HCC who underwent Gd-EOB-DTPA-enhanced MRI within 2 weeks prior to liver partial resection or liver transplantation surgery from January 2015 to May 2018 in Nantong Third People's Hospital. According to the pathological results of the postoperative pathology, MVI was divided into MVI positive group and MVI negative group, and alpha fetoprotein (AFP) was recorded. In Gd-EOB-DTPA-enhanced MRI, qualitative indicators including whether the tumor signal was uniform, peritumoral enhancement, tumor capsule, tumor margin, peritumor hypointensity and presence of fat in the tumor were assessed. Quantitative indicators including tumor diameter and the increase rate of liver-to-muscle ratio(&Delta;LMR) of post-enhancement arterial phase, portal vein phase, transitional phase and hepatobiliary phase were assessed and recorded. Theχ2 test was used to compare the qualitative parameters of the MVI-negative group and the MVI-positive group, and the Mann-Whitney U test was used to compare the non-normal quantitative parameters. In both inclusion and non-inclusion of peritumor hypointensity cases in the hepatobiliary phase. The multivariate logistic regression analysis was performed to indicate independent variables after univariate analysis. The prediction probability 1 (pre-1) and the prediction probability 2 (pre-2) were obtained, and the two as independent variables. with MVI as the gold standard, using ROC to analyze the diagnostic efficacy of both for HCC MVI, and using Z test to compare the area under the ROC of pre-1 and pre-2. Results There were 27 lesions in 26 cases of MVI-positive group and 50 lesions in 44 cases of MVI-negative group. There was a statistically significant difference between the MVI-negative group and the MVI-positive group in peritumoral enhancement, tumor capsule, tumor margin and peritumor hypointensity in the hepatobiliary phase (P<0.05), and there was no statistically significant difference in gender distribution, tumor signal uniformity and intratumoral fat (P>0.05). There was significant difference in lesion diameter between MVI-negative group and MVI-positive group (P<0.05) while no significant difference in age, AFP value and&Delta;LMR between the two groups (P>0.05). Multivariate logistic regression analysis showed that tumor diameter, non-smooth tumor margin and peritumor hypointensity were independent risks of MVI when peritumor hypointensity was included, the sensitivity and specificity of the combined diagnosis of MVI were 77.8％ and 94.0％;Multivariate logistic regression analysis showed that tumor diameter and non-smooth tumor margin were independent risks of MVI when peritumor hypointensity was not included, the sensitivity and specificity of the combined diagnosis of MVI were 59.3％and 92.0％. The the area under the ROC of pre-1 and pre-2 were 0.900 and 0.816, their difference was statistically significant (P<0.05). Conclusion Gd-EOB-DTPA enhanced MRI can be used to predict HCC MVI preoperatively, especially peritumor hypointensity in hepatobiliary phase is important for the prediction of MVI.