目的 分析Gd-EOB-DTPA MRI动态增强扫描(DCE)影像特征与单发原发性肝细胞癌(HCC)微血管侵犯(MVI)的相关性,总结提示HCC MVI的MRI影像特征,探讨利用这些影像特征术前预测HCC MVI的可能性.方法 分析66例单发HCC的术前MRI资料,利用单因素及多因素Logistic回归分析分析MRI各项影像特征与MVI的相关性,并采用ROC曲线分析肿瘤直径对MVI的诊断价值.结果 单因素分析结果表明肿瘤直径(P=0.011)、肿瘤边缘(P=0.019)、瘤周强化(P=0.001)、肝胆特异性期瘤周低信号(P=0.002)是MVI的危险因素,肿瘤信号不均匀(P=0.157)、肿瘤包膜(P=0.207)、ADC值(P=0.481)、T1减低值比率(P=0.689)与MVI无相关性.多因素Logistic回归模型分析显示肿瘤直径(P=0.007;OR=1.024)与瘤周强化(P=0.005;OR=6.670)是MVI的独立危险因素.肿瘤直径的ROC分析显示肿瘤直径＞56 mm诊断MVI,AUC=0.741,敏感度为0.588,特异度为0.833.有瘤周强化组MVI的发生率是52.4％.结论 利用Gd-EOB-DTPA MRI动态增强扫描可术前预测HCC的MVI,肿瘤越大、有瘤周强化的HCC更容易出现MVI.%Objective To correlate preoperative dynamic Gd-EOB-DTPA-enhanced MRI with histopathological microvascular invasion (MVI) in solitary hepatocellular carcinoma (HCC).Methods The preoperative dynamic Gd-EOB-DTPA-enhanced MRI of 66 patients with HCC was analyzed and compared with the pathologic findings.Univariate,multiple logistic regression analyses were performed to determine the correlation and receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of tumor diameter.Results Univariate analysis showed that the tumor diameter (P=0.011),tumor margin (P=0.019),peritumor enhancement (P=0.001),and peritumor hypointensity in the hepatobiliary phase (P=0.002) were risk factors for MVI.The signal homogeneity (P=0.157),tumor capsule (P=0.207),ADC values (P=0.481),and T1 reduction ratio (P=0.689) did not correlate with MVI.Multiple logistic regression analysis showed that the tumor diameter (P=0.007;OR=1.024) and peritumor enhancement (P=0.005;OR=6.670) were independent risk factors for MVI.At a cutoff value of tumor size ＞56 mm,the area under the curve was 0.741 for predicting microvascular invasion with 58.8％ sensitivity and 83.3％ specificity in ROC curve analysis.The incidence rate of MVI was 52.4％ in peritumor enhancement.Conclusion Preoperative dynamic Gd-EOB-DTPA-enhanced MRI has predictive value for MVI in HCC.MVI is more likely in larger tumors or peritumor enhancement.
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