全瘤及瘤周感兴趣体积双区域T1 mapping定量参数结合钆塞酸二钠增强MRI对肝细胞癌微血管侵犯的评估价值
doi: 10.12122/j.issn.1674-4500.2023.03.05
Value of quantitative parameters of T1 mapping obtained from volume of interest of tumor and peritumoral combined with gadoxetic acid-enhanced MRI in evaluating microvascular invasion of hepatocellular carcinoma
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摘要:
目的 探讨全瘤及瘤周感兴趣体积（VOI）双区域T1 mapping定量参数结合钆塞酸二钠增强MRI对肝细胞癌微血管侵犯（MVI）的评估价值。 方法 对我院2019年1月~2022年9月术后病理诊断为单发性肝细胞癌的72例患者进行回顾性分析，并根据MVI表达状态分为MVI阳性组（n=23）、MVI阴性组（n=49）。术前行钆塞酸二钠增强MRI T1 mapping扫描，得到平扫（Pre）、肝胆期（HBP）两期的T1 mapping图像。利用3D Slicer软件逐层勾画出全瘤（tumor）、瘤周（peritumor）、全瘤+瘤周的VOI并得到VOItumor、VOIperitumor 1 cm、VOIperitumor 2 cm、VOItumor+1 cm、VOItumor+2 cm，测量出各个VOI的定量参数—T1弛豫时间（T1rt）和T1弛豫时间减低率（rrT1rt），比较MVI阳性组及阴性组间定量参数的差异，采用ROC曲线和净重分类指数（NRI）分析各定量参数的诊断效能。 结果 两组间T1rt-Pre-VOItumor、T1rt-Pre-VOI peritumor 1 cm、T1rt-Pre-VOItumor+1 cm、T1rt-Pre-VOItumor+2 cm、T1rt-HBP-VOItumor、T1rt-HBP-VOItumor+ 1 cm、T1rt-HBP-VOItumor+ 2 cm、rrT1rt-VOItumor+ 2 cm差异均有统计学意义（P < 0.05），其AUC值为0.720、0.689、0.748、0.730、0.727、0.726、0.717、0.639。多期参数T1rt-Pre-HBP-VOItumor、T1rt-Pre-HBP-VOItumor+1 cm、T1rt-Pre-HBP-VOItumor+2 cm的AUC值为0.740、0.756、0.743，其中T1rt-Pre-HBP-VOItumor+1 cm的诊断效能最高。NRI分析得出T1rt-Pre-VOItumor+1 cm、T1rt-HBP-VOItumor+1 cm与T1rt-Pre-VOItumor+2 cm、T1rt-HBP-VOItumor+2 cm比较均具有正向改善，NRI值为0.6158、0.4011。T1rt-Pre-HBP-VOItumor+1 cm分别与T1rt-Pre-VOItumor+1 cm、T1rt-HBP-VOItumor+1 cm比较均具有正向改善，NRI值分别为0.0692、0.5643。 结论 平扫、肝胆期的全瘤T1弛豫时间具有较好的诊断效能，且结合瘤周1 cm的T1弛豫时间诊断效能高于结合瘤周2 cm。多期T1弛豫时间的诊断效能高于单期，T1rt-Pre-HBP-VOItumor+1 cm诊断效能最高。 Abstract:Objective To investigate the value of dual-region T1 mapping quantitative parameters of whole tumor and peritumoral volume of interest (VOI) combined with GD-EOB-DTPA enhanced MRI in evaluating microvascular invasion (MVI) of hepatocellular carcinoma. Methods From January 2019 to September 2022, 72 patients with single hepatocellular carcinoma diagnosed by postoperative pathology in our hospital were retrospectively analyzed. According to the expression status of MVI, it was divided into MVI positive group (n=23) and MVI negative group (n=49). GD-EOB-DTPA enhanced MRI T1 mapping scan was performed before operation, and T1 mapping images of pre-enhancement phase (Pre) and hepatobiliary phase (HBP) were obtained. The VOI of tumor, peritumoral and tumor plus peritumor were drawn layer by layer by using 3D Slicer software and VOItumor, VOIperitumor 1 cm, VOIperitumor 2 cm, VOItumor + 1 cm, VOItumor + 2 cm were obtained. The quantitative parameters of each VOI, T1 relaxation time (T1rt) and T1 relaxation time reduction rate (rrT1rt) were measured. We compared the differences of quantitative parameters between the two groups. ROC curve and net reclassification index (NRI) were used to analyze the diagnostic efficacy of each quantitative parameter. Results T1rt-Pre-VOItumor, T1rt-Pre-VOIperitumor 1 cm, T1rt-Pre- VOItumor + 1 cm, T1rt-Pre-VOItumor+2 cm, T1rt-HBP-VOItumor, T1rt-HBP-VOItumor+1 cm, T1rt-HBP-VOItumor+2 cm, rrT1rt-VOItumor+2 cm between the two groups were statistically significant (P < 0.05). The AUC were 0.720, 0.689, 0.748, 0.730, 0.727, 0.726, 0.717, 0.639. The AUC of multiphase quantitative parameter, T1rt-Pre-HBP-VOItumor, T1rt- Pre- HBP- VOItumor + 1 cm, T1rt-Pre-HBP-VOItumor + 2 cm, were 0.740, 0.756, 0.743, among which T1rt-Pre-HBP-VOItumor+ 1 cm had the highest diagnostic efficiency. NRI analysis showed that T1rt-Pre- VOItumor + 1 cm, T1rt- HBP- VOItumor + 1 cm had positive improvement compared with T1rt-Pre-VOItumor + 2 cm, T1rt-HBP-VOItumor + 2 cm. NRI values were 0.6158 and 0.4011. T1rt-Pre-HBP-VOItumor + 1 cm showed positive improvement compared with T1rt-Pre-VOItumo1 cm and T1rt-HBP-VOItumor + 1 cm, and the NRI values were 0.0692 and 0.5643, respectively. Conclusion The T1 relaxation time of tumor in Pre and HBP has good diagnostic efficacy for microvascular invasion in hepatocellular carcinoma. Combined with peritumoral 1 cm has higher diagnostic efficacy than peritumoral 2 cm. The diagnostic efficacy of multiphase quantitative parameter is higher than single-phase quantitative parameter and T1rt-Pre-HBP-VOItumor+1 cm is the highest. -
图 1 VOI的绘制以及T1弛豫时间的测量
Figure 1. The drawing of VOI and the measurement of T1 relaxation time. A: VOI of HBP tumor, T1rt- HBP- VOItumor=685.20 ms; B: VOI of HBP peritumor, T1rt-HBP-VOIperitumor 1cm=507.44 ms, T1rt-HBP-VOIperitumor 2cm=483.70 ms; C: VOI of HBP tumor and peritumor, T1rt-HBP-VOItumor+1cm=570.61 ms, T1rt-HBP-VOItumor+2cm=521.41 ms; D-F: Display 3D views of VOItumor, VOItumor+1cm, and VOItumor+2cm, re-spectively.
图 2 MVI阳性组与MVI阴性组HCC之间T1弛豫时间的比较
Figure 2. Comparisons of T1 relaxation time between MVI- positive and MVI-negative HCCs.
图 3 MVI阳性组与MVI阴性组HCC之间T1弛豫时间减低率的比较
Figure 3. Comparisons of reduction rate of T1 relaxation time between MVI-positive and MVI-negative HCCs.
图 4 MVI阴性组及阳性组具有代表性的T1 mapping图像
Figure 4. Representative T1 mapping images of MVI negative group and positive group. A-C: Male, 50-year-old, hepatocellular carcinoma grade 3, MVI positive. A: The tumor can be seen in T1 mapping pseudo- color image during Pre(white arrow), T1rt-Pre-VOItumor=1211.39 ms; B: The tumor can be seen in T1 mapping pseudo-color image during HBP (white arrow), T1rt- HBP-VOItumor=685.20 ms; C: Pathology showed tumor emboli in the microvessels around the tumor (in the yellow circle, HE, ×20); D- F: Male, 36- year- old, hepatocellular carcinoma grade 3, MVI negative. D: The tumor can be seen in T1 mapping pseudo- color image during Pre (white arrow), T1rt- Pre- VOItumor=1473.92 ms; E: The tumor can be seen in T1 mapping pseudo-color image during HBP(white arrow), T1rt-HBP-VOItumor=740.32 ms; F: Pathology showed that there were no tumor emboli in the microvessels around the tumor (HE staining, ×20).
表 1 两组间定量参数比较
Table 1. Comparative analysis of quantitative parameters between two groups
Quantitative parameters Sequence VOI MVI-(n=49) MVI+(n=23) t P Tumor 1125.98±188.28 1286.49±190.88 -3.358 < 0.05 Peritumor 1cm 947.15±136.58 1027.07±99.24 -2.508 < 0.05
PrePeritumor 2cm 934.34±131.72 989.24±90.64 -1.805 0.075 Tumor+1cm 1007.58±137.93 1157.16±155.87 -4.115 < 0.001 Tumor+2cm 969.74±129.74 1090.57±136.95 -3.620 < 0.001 T1rt Tumor 623.66±174.52 738.12±151.99 -2.699 < 0.05 Peritumor 1cm 352.84±113.69 407.73±107.99 -1.940 0.056
HBPPeritumor 2cm 331.12±104.73 364.41±101.66 -1.269 0.209 Tumor+1cm 442.26±139.13 561.88±149.81 -3.320 < 0.05 Tumor+2cm 381.6±119.82 482.87±135.65 -3.205 < 0.05 Tumor 44.23%±14.01% 42.46%±10.05% 0.543 0.589 Peritumor 1cm 63.10%±8.37% 60.52%±8.76% 1.203 0.233 rrT1rt - Peritumor 2cm 64.85%±8.01% 63.37%±8.66% 0.714 0.478 Tumor+1cm 56.56%±10.24% 51.83%±9.74% 1.857 0.068 Tumor+2cm 61.07%±8.92% 56.16%±9.27% 2.151 0.035 T1rt: T1 relaxation time; rrT1rt: Reduction rate of T1 relaxation time; Pre: Pre-enhancement phase; HBP: Hepatobiliary phase;
VOI: Volume of interest.
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表 2 两组间定量参数诊断效能分析
Table 2. Analysis of diagnostic efficacy of quantitative parameters between two groups
VOI Sensitivity(%) Specificity(%) AUC(95% CI) Youden index P Cut-off Pre-VOItumor 60.87 77.55 0.720(0.602-0.820) 0.38 < 0.001 1251.54 Pre-VOIperitumor 1cm 86.96 51.02 0.689(0.569-0.793) 0.38 < 0.05 937.62 Pre-VOItumor+1cm 78.26 61.22 0.748(0.632-0.843) 0.39 < 0.001 1044.27 Pre-VOItumor+2cm 60.87 81.63 0.730(0.613-0.828) 0.43 < 0.001 1044.24 HBP-VOItumor 65.22 79.59 0.727(0.609-0.825) 0.45 < 0.001 740.33 HBP-VOItumor+1cm 56.52 83.67 0.726(0.608-0.824) 0.40 < 0.001 560.41 HBP-VOItumor+2cm 52.17 85.71 0.717(0.598-0.817) 0.38 < 0.001 475.65 rrT1rt-VOItumor+2cm 43.48 87.76 0.639(0.517-0.749) 0.31 0.059 0.52 Pre-HBP-VOItumor 82.61 65.31 0.740(0.623-0.836)a 0.48 < 0.001 - Pre-HBP-VOItumor+1cm 65.22 77.55 0.756(0.640-0.850)a 0.43 < 0.001 - Pre-HBP-VOItumor+2cm 60.87 81.63 0.743(0.626-0.839)a 0.43 < 0.001 - aAUC value was obtained by regression equation.
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表 3 VOI间定量参数诊断效能比较分析
Table 3. Comparative analysis of diagnostic efficiency of quantitative parameters between VOI
Quantitative parameters Diverse combinations NRI（%） PNRI PAUC Pre-Tumor+1cm vs Pre-Tumor 52.88 0.029 0.653 HBP-Tumor+1cm vs HBP-Tumor 70.28 0.002 0.983 Pre-Tumor+2cm vs Pre-Tumor 32.48 0.184 0.873 HBP-Tumor+2cm vs HBP-Tumor 36.56 0.135 0.846 Pre-Tumor+1cm vs Pre-Tumor+2cm 61.58 0.009 0.492 HBP-Tumor+1cm vs HBP-Tumor+2cm 40.11 0.105 0.652 T1rt Pre-Tumor vs HBP-Tumor 36.56 0.134 0.922 Pre-Tumor+1cm vs HBP-Tumor+1cm 48.27 0.049 0.632 Pre-Tumor+2cm vs HBP-Tumor+2cm 31.94 0.198 0.733 Pre-HBP-Tumor vs Pre-Tumor 48.80 0.045 0.385 Pre-HBP-Tumor vs HBP-Tumor 44.19 0.073 0.767 Pre-HBP-Tumor+1cm vs Pre-Tumor+1cm 6.92 0.783 0.492 Pre-HBP-Tumor+1cm vs HBP-Tumor+1cm 56.43 0.021 0.444 NRI: Net reclassification improvement
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