Liver Imaging Reporting and Data System Category 5: MRI Predictors of Microvascular Invasion and Recurrence After Hepatectomy for Hepatocellular Carcinoma
Liver Imaging Reporting and Data System Category 5: MRI Predictors of Microvascular Invasion and Recurrence After Hepatectomy for Hepatocellular Carcinoma
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DOI：
10.2214/ajr.19.21168
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发表时间：
2019-10-01
影响因子：
5
通讯作者：
Wang, Jin
中科院分区：
文献类型：
--
作者：
Chen, Jingbiao;Zhou, Jing;Wang, Jin
目标。我们在肝成像报告和数据系统第5类(LR-5)观察中调查了包括LI-RADS成像特征在内的成像特征是否可以预测高危成人肝细胞癌(HCC)患者的微血管侵犯(MVI)和术后复发。我们回顾了149名高危患者，他们在接受肝切除术前1个月内接受了3-T MRI检查；149名无肝细胞癌复发的患者中，81名获得了超过1年的随访。手术切缘清楚的肿瘤在每个肝切除标本中都得到确认。由组织病理学专家对MVI进行组织学评估。肿瘤复发由临床和影像随访确定。两位独立的放射科医生回顾了肝切除术前的MR图像，并一致评估了所有LR-5观测中的Li-RADS v2018成像特征以及一些非LI-RADS特征。多因素Logistic回归和COX比例风险模型分析甲胎蛋白水平、肿瘤数目和影像特征是预测甲胎蛋白水平和术后复发的潜在因素。结果：149例经病理证实的肝细胞癌患者中，(43.0%)有甲胎蛋白水平，而48(37.2%)例患者在肝切除术后3年内肿瘤复发。马赛克结构(优势比，3.420；p<；0.001)和肿瘤边缘不光滑(优势比，2.554；p=0.011)是MVI的独立预测因素。多灶性肿瘤(风险比，2.101；p=0.034)、无脂肪肿块(风险比，2.109；p=0.015)和非光滑肿瘤边缘(风险比，2.415；p=0.005)是术后复发的独立预测因素。结论：在LR-5肝癌高危患者中，马赛克结构和非光滑肿瘤边缘独立预测MVI。多灶性肿瘤、肿块内无脂肪和肿瘤边缘不光滑独立预测复发。
OBJECTIVE. We investigated in Liver Imaging Reporting and Data System category 5 (LR-5) observations whether imaging features, including LI-RADS imaging features, could predict microvascular invasion (MVI) and posthepatectomy recurrence in high-risk adult patients with hepatocellular carcinoma (HCC).MATERIALS AND METHODS. We retrospectively identified 149 high-risk patients who underwent 3-T MRI within 1 month before hepatectomy for HCC; 81 of 149 patients with no HCC recurrence were followed for more than 1 year. Tumors with clear surgical margins were confirmed in each hepatectomy specimen. MVI was evaluated histologically by a histopathologist. Tumor recurrence was determined by clinical and imaging follow-up. Two independent radiologists reviewed the prehepatectomy MR images and assessed LI-RADS v2018 imaging features as well as some non-LI-RADS features in all LR-5 observations in consensus. Alpha-fetoprotein level, tumor number, and imaging features were analyzed as potential predictors for MVI and posthepatectomy recurrence using multivariate logistic regression and Cox proportional hazards models.RESULTS. One hundred forty-nine patients with pathologically confirmed HCC were included; 64 of 149 (43.0%) patients had MVI, whereas 48 of 129 (37.2%) patients had tumor recurrence within 3 years after hepatectomy. Mosaic architecture (odds ratio, 3.420; p < 0.001) and nonsmooth tumor margin (odds ratio, 2.554; p = 0.011) were independent predictors of MVI. Multifocal tumors (hazard ratio, 2.101; p = 0.034), absence of fat in mass (hazard ratio, 2.109; p = 0.015), and nonsmooth tumor margin (hazard ratio, 2.415; p = 0.005) were independent predictors of posthepatectomy recurrence.CONCLUSION. In high-risk patients with LR-5 HCC, mosaic architecture and nonsmooth tumor margin independently predicted MVI. Multifocal tumors, absence of fat in mass, and nonsmooth tumor margin independently predicted recurrence.