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目的研究肝细胞癌(HCC)钆塞酸增强MR成像的影像表现模式,并评估其作为HCC术后肿瘤复发的预后指标的潜在价值。材料与方法本次回顾性研究经机构审查委员会批准,并免除知情同意书。本研究纳入外科手术前行钆塞酸增强MR成像的216例病人的304个经病理证实的HCC。对临床资料不知情的2名观察者,评价HCC成像模式并达成一致。成像模式评价包括动态期影像增强方式及肝胆管期(HBP)影像信号强度。应用Student t检验、χ2检验、Mann-Whitney U检验和linearby线性关联评价成像特征与临床病理学的关联。应用Kaplan-Meier法、log-rank检验和Cox比例风险模型评估术后肿瘤复发时间(TTR)的依赖性。结果具有不典型增强方式(分别为P=0.0167,P=0.0450,P<0.0001)和HBP影像等高信号(分别P=0.0001,P=0.0002,P<0.0001)的HCC其肿瘤尺寸较小,组织学分级较低,Child-Pugh分级较差。log-rank检验(P=0.0064)和Cox比例风险模型(危险比为5.676,P=0.0158)显示HBP影像等高信号的HCC的TTR显著长于HBP影像低信号的HCC。结论 HCC钆塞酸增强MR影像可分为多种与肿瘤侵袭性和预后有关成像模式。此外,HBP影像等高信号可能是指示术后较长TTR的有用的成像生物标记。
Objective To study the imaging modality of enhanced hepatocellular carcinoma (HCC) with gadolinium acid and to evaluate its potential value as a prognostic marker of tumor recurrence after HCC. Materials and Methods The retrospective study was approved by the institutional review board and exempted from informed consent. This study included 304 pathologically confirmed HCC in 216 patients who underwent preoperative gadolinium-enhanced MR imaging. Two observers, who did not know the clinical data, evaluated the HCC imaging pattern and agreed. Evaluation of imaging modalities include dynamic phase contrast enhancement and hepatobiliary (HBP) image signal intensity. Student t-test, χ2 test, Mann-Whitney U test and linear correlation were used to evaluate the correlation between imaging features and clinicopathology. Kaplan-Meier method, log-rank test and Cox proportional hazards model were used to evaluate the dependence of postoperative tumor recurrence time (TTR). Results HCC with atypical enhancement (P = 0.0167, P = 0.0450, P <0.0001, respectively) and HBP images (P = 0.0001, P = 0.0002, P <0.0001, respectively) Lower grades, lower Child-Pugh grades. The log-rank test (C = 0.0064) and the Cox proportional hazards model (risk ratio 5.676, P = 0.0158) showed that the TTR of HCC with HBP imaging is significantly longer than that of HBP with low signal of HBP. Conclusion HCC gadoxate enhanced MR images can be divided into a variety of tumor invasion and prognosis related imaging modalities. In addition, contour signals such as HBP images may be useful imaging biomarkers for postoperative long TTR.