摘要
目的 探讨肝硬化伴小肝癌的多参数磁共振成像(Mp-MRI)、肝脏影像报告和数据管理(LI-RADS)系统影像特征,并分析联合血清甲胎蛋白的诊断及疗效评估价值.方法 选取2020年5月至2022年1月张家口市第一医院收治的65例肝硬化伴小肝癌患者为研究组,另选取同期65例单纯肝硬化患者为对照组,均行Mp-MRI检查,获取Mp-MRI参数[表观扩散系数(ADC)、增强率、平均强化时间(MET)、最大上升斜率(MSI)、最大下降斜率(MSD)、脂肪分数],根据MRI检查进行LI-RADS分级,比较两组Mp-MRI参数、LI-RADS分级,检测血清甲胎蛋白;分析Mp-MRI、LI-RADS及血清甲胎蛋白对肝硬化伴小肝癌的诊断价值.研究组患者接受肝癌根治术治疗,术后6个月复查Mp-MRI、血清甲胎蛋白并进行LI-RADS分级,根据术后小肝癌是否复发分为复发组(n=21)、未复发组(n=44),比较两组术后6个月Mp-MRI参数、血清甲胎蛋白及LI-RADS分级,分析Mp-MRI、LI-RADS影像特征联合血清甲胎蛋白对肝硬化伴小肝癌患者的疗效评估价值.结果 研究组的ADC、增强率、MET、MSI分别为(0.98±0.22)×10-3mm2/s、(67.51±10.75)％、(511.78±15.90)s、106.47±27.53,均低于对照组,MSD、脂肪分数及血清甲胎蛋白分别为113.59±30.06、(4.62±1.53)Hz、(257.24±64.33)ng/mL,均高于对照组,差异均有统计学意义(P＜0.05).研究组阳性(LR-4、LR-5)占比高于对照组,差异有统计学意义(P＜0.05).Mp-MRI参数、LI-RADS及血清甲胎蛋白联合诊断肝硬化伴小肝癌的ROC曲线AUC为0.927.术后6个月,复发组的ADC、增强率、MET、MSI分别为(1.01±0.12)× 10-3mm2/s、(69.02±9.85)％、(511.54±11.34)s、113.41±15.77,均低于未复发组,MSD、脂肪分数及血清甲胎蛋白分别为 110.36±12.08、(4.36±1.55)Hz、(239.57±40.17)ng/mL,均高于未复发组,差异均有统计学意义(P＜0.05).术后6个月Mp-MRI参数、LI-RADS及血清甲胎蛋白联合评估肝硬化伴小肝癌术后复发风险的ROC曲线AUC为0.924.结论 肝硬化伴小肝癌的Mp-MRI、LI-RADS影像特征存在显著差异,Mp-MRI、LI-RADS联合血清甲胎蛋白对肝硬化伴小肝癌的诊断及疗效评估价值较高.
Abstract
Objective To investigate the imaging characteristics of multi-parameter magnetic resonance imaging(Mp-MRI)and liver image reporting and data management(LI-RADS)systems in patients with liver cirrhosis combined with small hepatic carcinoma,and to analyze the value of diagnosis and efficacy evaluation of combined serum alpha-fetoprotein,so as to provide evidence for clinical diagnosis and disease control.Methods A total of 65 patients with liver cirrhosis combined with small hepatic carcinoma admitted to Zhangjiakou First Hospital from May 2020 to January 2022 were selected as the study group,and 65 patients with simple LC were selected as the control group during the same pe-riod.Mp-MRI was performed after admission.Mp-MRI parameters[apparent diffusion coefficient(ADC),enhancement rate,mean enhance-ment time(MET),maximum slope ascending(MSI),maximum slope decline(MSD),fat fraction]were obtained,and LI-RADS classification was performed according to MRI examination.Mp-MRI parameters and LI-RADS classification were compared.Serum alpha-fetoprotein were detected.And the diagnostic value of Mp-MRI,LI-RADS and serum alpha-fetoprotein in liver cirrhosis combined with small hepatic carcino-ma was analyzed.Patients in the study group were treated with radical hepatocellular carcinoma.Mp-MRI,serum AFP and LI-RADS classifica-tion were performed at 6 months after surgery.According to whether SHCC recurred after surgery,patients were divided into relapse group(n=21)and non-recurrence group(n=44).The Mp-MRI parameters,serum alpha-fetoprotein and LI-RADS grade were also compared 6 months after surgery,and the efficacy evaluation value of Mp-MRI and LI-RADS combined with serum AFP in patients with liver cirrhosis com-bined with small hepatic carcinoma was analyzed.Results ADC,enhancement rate,MET and MSI of the study group were(0.98±0.22)x 10-3mm2/s,(67.51±10.75)％,(511.78±15.90)s,106.47±27.53,respectively,which were lower than those of the control group,while MSD,fat fraction and serum alpha-fetoprotein of the study group were 113.59±30.06,(4.62±1.53)Hz,(257.24±64.33)ng/mL,re-spectively,which were higher than those of the control group,the differences were statistically significant(P＜0.05).The proportion of positive(LR-4,LR-5)in the study group was higher than that in the control group,the difference was statistically significant(P＜0.05).The ROC curve AUC of Mp-MRI parameters,LI-RADS and serum alpha-fetoprotein in combination diagnosis of LC-SHCC was 0.927.At 6 months after surgery,ADC,enhancement rate,MET and MSI were(1.01±0.12)x10-3mm2/s,(69.02±9.85)％,(511.54±11.34)s,113.41±15.77,respectively,whichwere lower than those in the non-recurrence group,MSD,fat fraction and serum AFP in the relapse group 110.36±12.08,(4.36±1.55)Hz,(239.57±40.17)ng/mL,respectively,which were higher than those in the non-recurrence group,the differences were statistically significant(P＜0.05).ROC curve AUC of Mp-MRI parameters,LI-RADS and serum alpha-fetoprotein combined to evalu-ate the risk of postoperative recurrence of liver cirrhosis combined with small hepatic carcinoma at 6 months after surgery were 0.924,respectively.Conclusion There are significant differences in Mp-MRI and LI-RADS imaging features of liver cirrhosis combined with small hepatic carcino-ma.Mp-MRI and LI-RADS combined with serum alpha-fetoprotein are of high value in the diagnosis and efficacy evaluation of liver cirrhosis combined with small hepatic carcinoma.
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