体素内不相干运动成像判断肝细胞癌的病理分级

李谋; 郑兴菊; 黄子星等

体素内不相干运动成像判断肝细胞癌的病理分级

Predicting Histological Grade of HCC in Rats using Intravoxel Incoherent Motion Imaging

摘要

摘要: 目的评估核磁共振成像（MRI）中运用体素内不相干运动成像（IVIM）判断Wistar大鼠肝细胞癌（HCC）的病理分级。方法采用饮水中加入二乙基亚硝胺（DEN）制备大鼠HCC模型，运用IVIM扫描大鼠肝组织病灶，获得表观扩散系数(apparent diffusion coefficient， ADC)值和IVIM参数值〔包括真性扩散系数（D）、假性扩散系数（D*）及灌注分数（f)〕，扫描完成后处死大鼠，取肝组织病灶行HE染色，对判断建模成功的HCC病灶行Edmondson-Steiner病理分级，按病理分级分为低级别组（Ⅰ+Ⅱ级）和高级别组（Ⅲ+Ⅳ级）HCC，比较两组ADC和IVIM参数值，应用ROC曲线分析上述参数的诊断效能。结果48只大鼠成功建立HCC模型，共获取50个HCC病灶，其中28个低级别HCC和22个高级别HCC。高级别组HCC的ADC值、D值均低于低级别组（P=0.009，0.005），高级别组HCC的D*值、f值高于低级别组（P=0.032，0.044），提示ADC及IVIM参数均能鉴别高、低级别HCC。ROC曲线分析显示，ADC、D、D*及f值为0.907 8×10^-3 mm²/s、0.817 6×10^-3 mm²/s、24.31×10^-3 mm²/s、14.4%时，约登指数最大，但各参数值ROC曲线下面积（AUC）两两比较，差异均无统计学意义（P＞0.05），其AUC均＞0.5，且＜0.9，说明ADC、D、D*及f判断HCC病理分级的诊断效能无明显差异，诊断效能为中等。结论ADC及IVIM参数均能单独鉴别高、低级别HCC，有助于术前评估HCC的病理分级。

Abstract: ObjectiveTo predict histological grade of hepatocellular carcinoma (HCC) in Wistar rats using intravoxel incoherent motion imaging (IVIM) with magnetic resonance imaging (MRI). MethodsLiver lesions of HCC rat models induced by oral diethylnitrosamine (DEN) were scanned by IVIM to obtain apparent diffusion coefficient (ADC) and IVIM parameters, including true diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (f). These HCC lesions were confirmed by Hematoxylin-Eosin (HE) stain and pathologically graded into low (grade Ⅰ+Ⅱ) and high (grade Ⅲ+Ⅳ) using the Edmondson-Steiner method. The ADC and IVIM parameters of the two grade groups were compared: their diagnostic performance were assessed using ROC curves. ResultsHCC models were successfully established in 48 rats, containing 50 HCC lesions (28 low-grade and 22 high-grade). The high-grade lesions had lower ADC (P=0.009) and D (P=0.005) values and higher D* (P=0.032) and f (P=0.044) values compared with the low-grade lesions. The largest jonden index appeared in the ROC curves at 0.907 8×10^-3 mm²/s of ADC, 0.817 6×10^-3 mm²/s of D, 24.31×10^-3 mm²/s of D*, and 14.4% of f, respectively. The area under curves (AUCs) of these parameters ranged from 0.5 to 0.9, showing no significant differences (P>0.05). ConclusionADC and IVIM parameters have equal and moderate diagnostic values in predicting histologic grade of HCCs，which can be used for estimating pathological grading of HCCs before surgery.

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