动态对比增强MRI三维直方图定量参数鉴别肝细胞癌和结直肠腺癌肝转移瘤异质性的价值

doi:10.12117/jccmi.2019.10.009

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摘要目的：探讨动态对比增强MRI（DCE-MRI）三维直方图定量参数鉴别肝细胞癌（Hepatocellular carcinoma，HCC）和结直肠腺癌肝转移瘤异质性的价值。方法：回顾性分析经病理证实且术前均行腹部常规MRI和DCE-MRI检查的HCC或肝转移瘤病例59例，其中HCC 41例，肝转移瘤18例。运用肝脏双血供双输入Extended Tofts模型，三维全病灶勾画ROI，获得DCE-MRI灌注参数，包括转运常数（Ktrans）、速率常数（Kep）、血管外细胞外间隙容积分数（Ve）、血管（血浆）间隙容积分数（Vp）和肝动脉供血比例（HPI）。进行三维Histogram分析，获得上述参数的中位数、平均数、偏度、峰度、能量、熵、10%位数、90%位数。采用独立样本t检验和Mann-Whitney U检验比较各参数间差异。绘制ROC曲线，分析各参数鉴别诊断HCC和肝转移瘤的效能。结果：HCC和肝转移瘤的三维直方图定量参数中，Ktrans、Kep（中位数、平均数、10%位数、90%位数），Kep能量、熵，Ve中位数、偏度、10%位数、90%位数，Vp偏度、峰度、能量、熵、90%位数和HPI中位数、平均数、90%位数的差异有统计学意义（P<0.05），余参数差异均无统计学意义（P>0.05）。其中Kep 90%位数的ROC下面积（AUC）最大（0.930）。结论：DCE-MRI三维直方图定量参数可用于鉴别HCC和结直肠腺癌肝转移瘤的异质性，其中Kep 90%位数具有较高诊断效能。

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关键词 ：癌, 肝细胞, 直肠肿瘤, 肿瘤转移, 磁共振成像

Abstract：Objective: To investigate the value of quantitative parameters of three dimensional histogram by dynamic contrast enhanced MRI(DCE-MRI) in the differential diagnosis of the heterogeneity of hepatocellular carcinoma(HCC) and hepatic metastases of colorectal adenocarcinoma. Methods: A total of 59 cases pathologically confirmed as HCC or hepatic metastases who had routine abdominal MRI and DWI scans were retrospectively analyzed. There were 41 cases of HCC and 18 cases of hepatic metastases. Liver double blood supplement and dual-input extended Tofts model were used, and 3D ROIs of all lesions were delineated to get the perfusion parameters of DCE-MRI, including transfer constant(Ktrans), rate constant(Kep), extravascular extracellular volume fraction(Ve), blood plasma space volume fraction(Vp) and hepatic arterial perfusion index(HPI).Then the three dimensional histogram analysis of these parameters was performed to get the median, mean, skewness, kurtosis, energy, entropy, 10th percentile, 90th percentile. We used independent t test and Mann-Whitney U test to compare the differences of the parameters, and drew the ROC curves to evaluate the value of the parameters in the differential diagnosis of HCC and hepatic metastases. Results: There were significant differences between HCC and hepatic metastases in Histogram-based Ktrans, Kep(median, mean, 10th, 90th), Kep(energy, entropy), Ve(median, skewness, 10th, 90th), Vp(skewness, kurtosis, energy, entropy, 90th) and HPI(median, Mean, 90th)(P<0.05). There was no significant difference in the rest of the parameters(P>0.05).The Kep(90th) had the highest area under curve(AUC, 0.930). Conclusion: The quantitative parameters of three dimensional histogram of DCE-MRI can be used to identify the heterogeneity of HCC and hepatic metastases of colorectal adenocarcinoma. Among these parameters, the Kep(90th) has a high diagnostic efficiency.

Key words： Carcinoma, hepatocellular Rectal neoplasms Neoplasm metastasis Magnetic resonance imaging

收稿日期: 2018-11-06

PACS:	Ｒ735.7
	Ｒ735.37
	Ｒ445.2

基金资助:浙江省自然科学基金（LY16H180006）；浙江省医药卫生科技计划一般项目（2018KY170）；浙江省医药卫生平台计划（骨干人才A类）（2015RCA024）。

通讯作者: 赵振华，浙江大学绍兴医院（绍兴市人民医院）放射科，312000。E-mail：zhao2075@163.com

作者简介: 朱旅聪（1990-），女，浙江仙居人，医师。现工作单位为绍兴文理学院附属医院放射科。E-mail：644921468@qq.com

引用本文:

朱旅聪1，赵振华1，杨建峰1，黄亚男1，王挺1，张雅萍1，卢增新1，杨立铭1，孙军辉2. 动态对比增强MRI三维直方图定量参数鉴别肝细胞癌和结直肠腺癌肝转移瘤异质性的价值[J]. 中国临床医学影像杂志, 2019, 30(10): 721-725.
ZHU Lv-cong1, ZHAO Zhen-hua1, YANG Jian-feng1, HUANG Ya-nan1, WANG Ting1, . Value of quantitative parameters of three dimensional histogram by dynamic contrast enhanced MRI in differential diagnosis of the heterogeneity of hepatocellular carcinoma and hepatic metastases of colorectal adenocarcinoma. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(10): 721-725.

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http://www.jccmi.com.cn/CN/10.12117/jccmi.2019.10.009 或 http://www.jccmi.com.cn/CN/Y2019/V30/I10/721

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