国际肿瘤学杂志

国际肿瘤学杂志 ›› 2026, Vol. 53 ›› Issue (5): 290-295.doi: 10.3760/cma.j.cn371439-20250704-00047

• 论著 • 上一篇    下一篇

钆塞酸二钠增强MRI联合DWI成像对肝细胞癌血管包绕肿瘤细胞簇阳性的评估价值

张状1(), 王倩2, 杨愈佳3, 魏海阔1, 刘畅1   

  1. 1 秦皇岛市第二医院医学影像科， 秦皇岛 066000
    2 秦皇岛市第二医院麻醉科， 秦皇岛 066000
    3 河北北方学院研究生部， 张家口 075000
  • 收稿日期:2025-07-04 出版日期:2026-05-08 发布日期:2026-05-06
  • 通讯作者: 张状，Email： padd20220727@163.com
  • 基金资助:
    秦皇岛市科学技术研究与发展计划(202501A189)

Value of Gd-EOB-DTPA enhanced MRI combined with DWI in evaluating vessels encroachment tumor clusters in hepatocellular carcinoma

Zhang Zhuang1(), Wang Qian2, Yang Yujia3, Wei Haikuo1, Liu Chang1   

  1. 1 Department of Medical Imaging， Second Hospital of Qinhuangdao， Qinhuangdao 066000
    2 Department of Anesthesiology， Second Hospital of Qinhuangdao， Qinhuangdao 066000， China
    3 Graduate Faculty， Hebei North University， Zhangjiakou 075000， China
  • Received:2025-07-04 Online:2026-05-08 Published:2026-05-06
  • Supported by:
    Qinhuangdao S&T Plan Program of China(202501A189)

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摘要：

目的 研究钆塞酸二钠（Gd-EOB-DTPA）增强MRI联合弥散加权成像（DWI）对肝细胞癌（HCC）患者血管包绕肿瘤细胞簇（VETC）阳性的评估价值。方法 回顾性选取2023年1月至2024年12月秦皇岛市第二医院收治的116例HCC患者作为研究对象，均于术前7 d内进行Gd-EOB-DTPA增强MRI和DWI检查，依据术后病理结果将其分为VETC阳性组（n=35）和VETC阴性组（n=81），比较两组影像学特征和表观扩散系数（ADC）值，采用多因素logistic回归分析HCC患者VETC阳性的影响因素，绘制受试者操作特征（ROC）曲线分析各参数对HCC患者VETC阳性的评估价值。结果 VETC阳性组肿瘤边缘不光滑、动脉期瘤周强化、肝胆特异性瘤周低信号发生率分别为51.43%（18/35）、42.86%（15/35）、54.29%（19/35），均高于VETC阴性组的25.93%（21/81）、16.05%（13/81）、18.52%（15/81），差异均有统计学意义（χ2=7.12，P=0.008；χ2=9.59，P=0.002；χ2=15.09，P<0.001）。VETC阳性组ADC值为（1.05±0.30）×10-3 mm2/s，低于VETC阴性组的（1.28±0.44）×10-3 mm2/s（t=2.82，P=0.006）。多因素logistic回归分析显示，动脉期瘤周强化（OR=1.40，95%CI为1.12~1.74，P=0.003）、肝胆特异性瘤周低信号（OR=1.43，95%CI为1.13~1.81，P=0.003）、ADC值降低（OR=1.49，95%CI为1.20~1.86，P<0.001）均为HCC患者VETC阳性的独立危险因素。ROC曲线分析显示，动脉期瘤周强化、肝胆特异性瘤周低信号、ADC值降低及三项联合检测预测HCC患者VETC阳性的曲线下面积（AUC）分别为0.695、0.684、0.725、0.855，三项联合检测预测HCC患者VETC阳性的AUC均高于单项检测（Z=2.08，P=0.038；Z=2.86，P=0.004；Z=2.97，P=0.003）。结论 Gd-EOB-DTPA增强MRI联合DWI对HCC患者VETC阳性的评估价值较高，有助于指导个体化治疗方案和预后评估。

关键词: 癌，肝细胞, 血管包绕肿瘤细胞簇阳性, 钆塞酸二钠, MRI, 弥散加权成像

Abstract:

Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid （Gd-EOB-DTPA） enhanced MRI combined with diffusion weighted imaging （DWI） in evaluating vessels encroachment tumor clusters （VETCs） in patients with hepatocellular carcinoma （HCC）. Methods A retrospective study was conducted and 116 patients with HCC admitted to the Second Hospital of Qinhuangdao from January 2023 to December 2024 were selected for the study. All patients underwent Gd-EOB-DTPA-enhanced MRI and DWI examinations within 7 d before surgery. Based on postoperative pathological results， the patients were divided into VETC positive group （n=35） and VETC negative group （n=81）. Imaging features and apparent diffusion coefficient （ADC） values of the two groups were compared. Multivariate logistic regression was utilized to analyze the influencing factors of VETC in patients with HCC， and the receiver operator characteristic （ROC） curve was plotted to analyze the value of each parameters in evaluating VETC in patients with HCC. Results The incidence rates of rough tumor margins， peritumoral enhancement in arterial phase， and hepatobiliary specific peritumoral hypointensity in the VETC positive group [51.43% （18/35）， 42.86% （15/35）， 54.29% （19/35）] were higher than those in the VETC negative group [25.93% （21/81）， 16.05% （13/81）， 18.52% （15/81）]， with statistically significant differences （χ2=7.12， P=0.008； χ2=9.59， P=0.002； χ2=15.09， P<0.001）. The ADC value of the VETC positive group [（1.05±0.30）×10-3 mm2/s] was lower than that of the VETC negative group [（1.28±0.44）×10-3 mm2/s] （t=2.82， P=0.006）. Multivariate logistic regression analysis showed that peritumoral enhancement in arterial phase （OR=1.40， 95%CI： 1.12-1.74， P=0.003）， hepatobiliary specific peritumoral hepatobiliary （OR=1.43， 95%CI： 1.13-1.81， P=0.003）， and decreased ADC value （OR=1.49， 95%CI： 1.20-1.86， P<0.001） were independent risk factors for VETC in patients with HCC. ROC curve analysis showed that the values of the area under the curve （AUC） of peritumoral enhancement in arterial phase， hepatobiliary specific peritumoral hypointensity， decreased ADC value， and the combined detection of the three for predicting VETC in HCC patients were 0.695， 0.684， 0.725， and 0.855， respectively. The AUC of the combined detection of the three for predicting VETC in HCC patients was higher than that of the individual detection （Z=2.08， P=0.038； Z=2.86， P=0.004； Z=2.97， P=0.003）. Conclusions Gd-EOB-DTPA enhanced MRI combined with DWI is of high value in evaluating VETC in patients with HCC， and can help to guide individualized treatment plan and evaluate the prognosis.

Key words: Carcinoma， hepatocyte, Vessels encapsulating tumor clusters positive, Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, MRI, Diffusion-weighted imaging