磁共振CDT-VIBE成像技术在肝细胞癌术前分级中的应用研究
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摘要
目的研究不同分化程度肝细胞肝癌(HCC)经CDT-VIBE成像技术扫描后所得定量参数的差异,探讨CDT-VIBE成像技术在HCC术前分级中的应用价值。方法搜集HCC患者55例,男44例,女11例,平均年龄(54.20±9.13)岁,所有患者均经外科手术或穿刺活检病理证实为HCC。采用国际上常用的Edmondson-Steiner四级(Ⅰ~Ⅳ)分级方法,其中Ⅰ、Ⅱ级纳入高级别组,Ⅲ、Ⅳ级纳入低级别组。扫描采用1.5 T磁共振扫描设备(Siemens Magnetom Area),包括常规腹部平扫,轴位T_1mapping及快速动态增强扫描。其中,快速动态增强扫描采用CDT-VIBE序列,单期扫描用时3 s,共连续扫描39期,于第4期后经肘静脉置管团注马根维显(0.2 ml/kg)。采用Siemens后处理工作站MMWP上的Tissue 4D软件处理图像,获取灌注相关参数,包括K~(trans)值、K_(ep)值、V_e值和iAUC值。利用SPSS 19.0软件,对不同分化程度的HCC病灶的上述参数进行分析,验证各参数差异有无统计学意义,并用ROC曲线对其进行诊断效能分析。结果高、低级别组及正常肝组织之间的K~(trans)值、K_(ep)值、V_e值及iAUC值,差异有统计学意义(P<0.01),其中高级别组K~(trans)、K_(ep)、V_e及iAUC明显高于低级别组,差异有统计学意义(P<0.01);K~(trans)值、K_(ep)值、V_e值及iAUC值的ROC曲线下面积分别为0.987、0.885、0.738、0.976,其中K~(trans)的诊断效能最佳。结论使用磁共振CDT-VIBE成像技术扫描所得定量参数对HCC进行术前分级,可以在一定程度上鉴别HCC的组织病理学分化程度,对临床选择合适的治疗方案及判断预后具有指导价值。
Objective To evaluate the difference of quantitative parameters of CDT-VIBE scanning technique in hepatocellular carcinoma( HCC) with various grades of differentiation. To investigate the value of CDT-VIBE imaging in preoperative grading of HCC. Methods 55 patients with hepatocellular carcinoma were collected,44 males and 11 females with an average age of 54. 20 ± 9. 13 years. All the HCC patients were confirmed by surgery or biopsy pathology. The first( Ⅰ) and second( Ⅱ) levels were included in the advanced group,and the third( Ⅲ) and fourth( Ⅳ) levels were included in the lower level group according to the Edmondson-Steiner four( Ⅰ-Ⅳ) classification method. The magnetic resonance scanning was performed using 1. 5 T equipment( Siemens Magnetom Area),including conventional abdominal scan,axial T_1 mapping and fast dynamic enhanced scanning. TWIST-VIBE sequence was used in fast dynamic enhanced scanning,with continuous scanning of 39 phases and single phase for 3 seconds. The injection of Magnetism( 0. 2 ml/kg)through elbow vein bolus was after fourth phase. The Tissue 4D software on Siemens post-processing workstation MMWP was used to process the images. The perfusion parameters were collected,including K~(trans),K_(ep),V_e and AUC values. SPSS 19 software was used to analyse the parameters of HCC lesions with different degrees of differentiation,and to verify the significance of each parameter. The ROC curve was used to analyze the diagnostic efficiency. Results There was significant difference in K~(trans),K_(ep),V_e and iAUC between high grade group,low grade group and normal hepatic tissue( P < 0. 01).The levels of K~(trans),K_(ep),V_e,iAUC in advanced group were higher than those in lower group,with significant difference( P <0. 01). The area under the curve of K~(trans),K_(ep),V_e and iAUC were 0. 987,0. 885,0. 738,0. 976,among them,the diagnostic efficiency of K~(trans)is optimum. Conclusion Quantitative classification with magnetic resonance CDT-VIBE imaging technique can be used to differentiate the grade of pathological differentiation of HCC,guide the clinical selection of appropriate treatment and determine prognosis.
Objective To evaluate the difference of quantitative parameters of CDT-VIBE scanning technique in hepatocellular carcinoma( HCC) with various grades of differentiation. To investigate the value of CDT-VIBE imaging in preoperative grading of HCC. Methods 55 patients with hepatocellular carcinoma were collected,44 males and 11 females with an average age of 54. 20 ± 9. 13 years. All the HCC patients were confirmed by surgery or biopsy pathology. The first( Ⅰ) and second( Ⅱ) levels were included in the advanced group,and the third( Ⅲ) and fourth( Ⅳ) levels were included in the lower level group according to the Edmondson-Steiner four( Ⅰ-Ⅳ) classification method. The magnetic resonance scanning was performed using 1. 5 T equipment( Siemens Magnetom Area),including conventional abdominal scan,axial T_1 mapping and fast dynamic enhanced scanning. TWIST-VIBE sequence was used in fast dynamic enhanced scanning,with continuous scanning of 39 phases and single phase for 3 seconds. The injection of Magnetism( 0. 2 ml/kg)through elbow vein bolus was after fourth phase. The Tissue 4D software on Siemens post-processing workstation MMWP was used to process the images. The perfusion parameters were collected,including K~(trans),K_(ep),V_e and AUC values. SPSS 19 software was used to analyse the parameters of HCC lesions with different degrees of differentiation,and to verify the significance of each parameter. The ROC curve was used to analyze the diagnostic efficiency. Results There was significant difference in K~(trans),K_(ep),V_e and iAUC between high grade group,low grade group and normal hepatic tissue( P < 0. 01).The levels of K~(trans),K_(ep),V_e,iAUC in advanced group were higher than those in lower group,with significant difference( P <0. 01). The area under the curve of K~(trans),K_(ep),V_e and iAUC were 0. 987,0. 885,0. 738,0. 976,among them,the diagnostic efficiency of K~(trans)is optimum. Conclusion Quantitative classification with magnetic resonance CDT-VIBE imaging technique can be used to differentiate the grade of pathological differentiation of HCC,guide the clinical selection of appropriate treatment and determine prognosis.
引文
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8 Othman AE,Martirosian P,Schraml C,et al.Feasibility of CAIPIRINHA-Dixon-TWIST-VIBE for dynamiccontrast-enhanced MRI of the prostate[J].Eur J Radiol,2015,84:2110-2116.
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14 Ng IO,Lai EC,Fan ST,et al.Prognostic significance of pathologic features of hepatocellular carcinoma:a multivariate analysis of 278patiens[J].Cancer,1995,76:2443-2448.
15 Breuer FA,Blaimer M,Mueller MF,et al.Controlled aliasing in volumetric parallel imaging(2D CAIPIRINHA)[J].Magn Reson Med,2006,55:549-556.
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18 Korosec FR,Frayne R,Grist TM,et al.Time-resolved contrast-enhanced 3D MR angiography[J].Magnetic Resonance in Medicine,1996,36:345-351.
19 Attenberger UI,Haneder S,Morelli JN,et a1.Peripheral Arterial Occlusive Disease:Evaluation of a High Spatial and Temporal Resolution 3-T MR Protocol with a Low Total Dose of Gadolinium versus Conventional Angiography[J].Radiology,2010,257:879-887.
20 Dixon WT.Simple proton spectroscopic imaging[J].Radiology,1984,153:l89-194.
21 刘亚涛,俎栋林,包尚联.水,脂分离磁共振成像Dixon方法[J].中国医学物理学杂志,2012,29:3759-3768.
22 Le Y,Kroeker R,Kipfer HD,et al.Development and evaluation of TWIST Dixon for dynamic contrast-enhanced(DCE)MRl with improved acquisition efficiency and fat suppression[J].Journal of Magnetic Resonance Imaging,2012,36:483-491.
23 Yamaguchi R,Yano H,Iemura A,et al.Expression of vascular endothelial growth factor in human hepatocellular carcinoma[J].Hepatology,1998,28:68-77.
24 Asayama Y,Yoshimitsu K,Nishihara Y,et al.Arterial blood supply of hepatocellular carcinoma and histologic grading:radiologic-pathologic correlation[J].AJR,2008,190:W28-34.
25 Kanematsu M,Osada S,Amaoka N,et al.Expression of vascular endothelial growth factor in hepatocellular carcinoma and the surrounding liver:correlation with angiographically assisted CT[J].AJR,2004,183:1585-1593.
26 Garcia EM,Storm ES,Atkinson L,et al.Current Breast Imaging Modalities,Advances,and Impact on Breast Care[J].Obstetrics and Gynecologv Clinics of North America,2013,40:429-457.
27 Nasu K,Kuroki Y,Tsukamoto T,et al.Diffusion-weighted imaging of surgically resected hepatocellular carcinoma:Imaging characteristics and relationship among signal intensity,apparent diffusion coefficient,and histopathologic grade[J].AJR,2009,193:438-444.
28 Jia Z,Geng D,Liu Y,et al.Low-grade and anaplastic oligodendrogliomas:differences in tumour microvascular permeability evaluated with dynamic contrast-enhanced magnetic resonance imaging[J].J Clin Neurosci,2013,20:1110-1113.
29 Huang B,Wong CS,Whitcher B,et al.Dynamic contrast-enhanced magnetic resonance imaging for characterising nasopharyngeal carcinoma:comparison of semiquantitative and quantitative parameters and correlation with tumour stage[J].Eur Radiol,2013,23:1495-1502.
30 Asayama Y,Yoshimitsu K,Irie H,et al.Poorly versus moderately differentiated hepatocellular carcinoma:vascularity assessment by computed tomographic hepatic angiography in correlation with histologically counted number of unpaired arteries[J].J Comput Assist Tomogr,2007,31:188-192.
31 Mineura K,Yasuda T,Kowada M,et al.PET evaluation of histologic malignancy in gliomas using15O and18F-FDG[J].Neurol Res,1986,8:164-168.
32 Kudo M.Imaging diagnosis of hepatocellular carcinoma and premalignant borderline lesions[J].Semin Liver Dis,1999,19:297-309.
2 Dong S,Ye XD,Yuan Z,et al.Relationship of apparent diffusion coefficient to survival forpatients with unresectable primary hepatocellular carcinoma after chemoembolization[J].Eur J Radiol,2012,8l:472-477.
3 Han KH.Prognostic significance of the worst grade in hepatocellular carcinoma with heterogeneous histologic grades of differentiation[J].Gastroenterol Hepatol,2013,28:1384-1390.
4 Nakajima Y,Shimamura T,Kamiyama T,et al.Evaluation of surgical resection for small hepatocellular carcinomas[J].Am J Surg,1996,171:360-363.
5 郝雯.CDT-VIBE在乳腺动态增强MRI中的临床适用性及时间参数对定量分析的影[D].山东:山东大学,2014.
6 徐佳.肝脏特异性磁共振增强成像定量评价大鼠肝纤维化与肝功能[D].北京:北京协和医学院,2015.
7 胡益祺.基于CAIPIRINHA-Dixon-TWIST-VIBE技术动态增强MRI对乳腺病变的定量参数分析[J].影像诊断与介入放射学,2016,25:98-101.
8 Othman AE,Martirosian P,Schraml C,et al.Feasibility of CAIPIRINHA-Dixon-TWIST-VIBE for dynamiccontrast-enhanced MRI of the prostate[J].Eur J Radiol,2015,84:2110-2116.
9 Tofts PS.Modeling tracer kinetics in dynamic Gd-DTPA MR imaging[J].Magn Reson Imaging,1997,7:91-101.
10 El-Serag HB.Hepatocellular carcinoma:an epidemiologic view[J].J Clin Gastroenterol,2002,35:S72-78.
11 Okuda K,Ohtsu T,Obata H,et al.Natural history of hepatocellular carcinoma and prognosis in relation to treatment:study of 850 patients[J].Cancer,1985,56:918-928.
12 Komorizono Y,Oketani M,Sako K,et al.Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session,single application of percutaneous radiofrequency ablation[J].Cancer,2003,97:1253-1262.
13 Nagasue N,Uchida M,Makino Y,et al.Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma[J].Gastroenterology,1993,105:488-493.
14 Ng IO,Lai EC,Fan ST,et al.Prognostic significance of pathologic features of hepatocellular carcinoma:a multivariate analysis of 278patiens[J].Cancer,1995,76:2443-2448.
15 Breuer FA,Blaimer M,Mueller MF,et al.Controlled aliasing in volumetric parallel imaging(2D CAIPIRINHA)[J].Magn Reson Med,2006,55:549-556.
16 Breuer FA,Blaimer M,Heidemann RM,et al.Controlled aliasing in parallel imaging results in higher acceleration(CAIPIRINHA)for multi-slice imaging[J].Magn Reson Med,2005,53:684-691.
17 Griswold MA.Basic Reconstruction Algorithms for Parallel Imaging.In:Schoenberg SO,Dietrich O,Reiser MF(eds).Parallel Imaging in C1inical MR Applications[J].Springer,Berlin Heidelberg New York,2007,pp 24-34.
18 Korosec FR,Frayne R,Grist TM,et al.Time-resolved contrast-enhanced 3D MR angiography[J].Magnetic Resonance in Medicine,1996,36:345-351.
19 Attenberger UI,Haneder S,Morelli JN,et a1.Peripheral Arterial Occlusive Disease:Evaluation of a High Spatial and Temporal Resolution 3-T MR Protocol with a Low Total Dose of Gadolinium versus Conventional Angiography[J].Radiology,2010,257:879-887.
20 Dixon WT.Simple proton spectroscopic imaging[J].Radiology,1984,153:l89-194.
21 刘亚涛,俎栋林,包尚联.水,脂分离磁共振成像Dixon方法[J].中国医学物理学杂志,2012,29:3759-3768.
22 Le Y,Kroeker R,Kipfer HD,et al.Development and evaluation of TWIST Dixon for dynamic contrast-enhanced(DCE)MRl with improved acquisition efficiency and fat suppression[J].Journal of Magnetic Resonance Imaging,2012,36:483-491.
23 Yamaguchi R,Yano H,Iemura A,et al.Expression of vascular endothelial growth factor in human hepatocellular carcinoma[J].Hepatology,1998,28:68-77.
24 Asayama Y,Yoshimitsu K,Nishihara Y,et al.Arterial blood supply of hepatocellular carcinoma and histologic grading:radiologic-pathologic correlation[J].AJR,2008,190:W28-34.
25 Kanematsu M,Osada S,Amaoka N,et al.Expression of vascular endothelial growth factor in hepatocellular carcinoma and the surrounding liver:correlation with angiographically assisted CT[J].AJR,2004,183:1585-1593.
26 Garcia EM,Storm ES,Atkinson L,et al.Current Breast Imaging Modalities,Advances,and Impact on Breast Care[J].Obstetrics and Gynecologv Clinics of North America,2013,40:429-457.
27 Nasu K,Kuroki Y,Tsukamoto T,et al.Diffusion-weighted imaging of surgically resected hepatocellular carcinoma:Imaging characteristics and relationship among signal intensity,apparent diffusion coefficient,and histopathologic grade[J].AJR,2009,193:438-444.
28 Jia Z,Geng D,Liu Y,et al.Low-grade and anaplastic oligodendrogliomas:differences in tumour microvascular permeability evaluated with dynamic contrast-enhanced magnetic resonance imaging[J].J Clin Neurosci,2013,20:1110-1113.
29 Huang B,Wong CS,Whitcher B,et al.Dynamic contrast-enhanced magnetic resonance imaging for characterising nasopharyngeal carcinoma:comparison of semiquantitative and quantitative parameters and correlation with tumour stage[J].Eur Radiol,2013,23:1495-1502.
30 Asayama Y,Yoshimitsu K,Irie H,et al.Poorly versus moderately differentiated hepatocellular carcinoma:vascularity assessment by computed tomographic hepatic angiography in correlation with histologically counted number of unpaired arteries[J].J Comput Assist Tomogr,2007,31:188-192.
31 Mineura K,Yasuda T,Kowada M,et al.PET evaluation of histologic malignancy in gliomas using15O and18F-FDG[J].Neurol Res,1986,8:164-168.
32 Kudo M.Imaging diagnosis of hepatocellular carcinoma and premalignant borderline lesions[J].Semin Liver Dis,1999,19:297-309.