Multiphase Liver MRI for Identifying the Macrotrabecular-Massive Subtype of Hepatocellular Carcinoma
Multiphase Liver MRI for Identifying the Macrotrabecular-Massive Subtype of Hepatocellular Carcinoma
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DOI：
10.1148/radiol.2020192230
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发表时间：
2020-06-01
期刊：
影响因子：
19.7
通讯作者：
Luciani, Alain
中科院分区：
文献类型：
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作者：
Mule, Sebastien;Pirgliasco, Athena Galletto;Luciani, Alain
背景：最近报道的肝细胞癌（HCC） （MTM-HCC）的“大小梁-块状”（MTM）组织学亚型是一种侵袭性HCC，与较差的生存率相关。目的：探讨术前MRI是否有助于HCC患者mtm -HCC的识别。材料和方法：本回顾性研究纳入了2008年1月至2018年2月期间接受手术切除的HCC患者，并进行了术前多期对比材料增强MRI检查。进行最小绝对收缩和选择算子（LASSO）惩罚和多变量逻辑回归分析，以确定与MTM-HCC亚型相关的临床、生物学和影像学特征。采用Kaplan-Meier分析早期复发率（2年内）和总复发率。采用多变量Cox回归分析确定早期和总复发的预测因素。结果：评估了152例hcc患者152例（中位年龄64岁，四分位数范围56-72岁，男性126例）。152例hcc中有26例（17%）为mtm - hcc。lasso惩罚logistic回归分析发现大量坏死，血清甲胎蛋白（AFP）水平高（p < 0.05）。100 ng/mL)，巴塞罗那临床肝癌（BCLC） B期或C期是与mtm - hcc相关的独立特征。在多变量分析中，实质坏死（优势比= 32；95%可信区间[CI] = 8.9, 114; P < 001）、高血清AFP水平（优势比= 4.4;95% CI = 1.3, 16; P = 0.02）和BCLC B期或C期（优势比= 4.2;95% CI = 1.2, 15; P = 0.03）是MTM-HCC亚型的独立预测因子。实质坏死有助于鉴别65%（26例中的17例；95% CI: 44%, 83%）的mtm - hcc（敏感性），特异性为93%（126例中的117例；95% CI: 87%, 97%）。在调整后的模型中，只有卫星结节的存在与早期（风险比= 3.7;95% CI: 1.5, 9.4; P = 0.006）和总体（风险比= 3.0;95% CI: 1.3, 7.2; P = 0.01）肿瘤复发独立相关。结论：在多期MRI增强检查中，实质性坏死有助于鉴别大梁-块状肝癌亚型，特异性高。(c) rsna, 2020
Background: The recently described "macrotrabecular-massive" (MTM) histologic subtype of hepatocellular carcinoma (HCC) (MTM-HCC) represents an aggressive form of HCC and is associated with poor survival.Purpose: To investigate whether preoperative MRI can help identify MTM-HCCs in patients with HCC.Materials and Methods: This retrospective study included patients with HCC treated with surgical resection between January 2008 and February 2018 and who underwent preoperative multiphase contrast material-enhanced MRI. Least absolute shrinkage and selection operator (LASSO)-penalized and multivariable logistic regression analyses were performed to identify clinical, biologic, and imaging features associated with the MTM-HCC subtype. Early recurrence (within 2 years) and overall recurrence were evaluated by using Kaplan-Meier analysis. Multivariable Cox regression analysis was performed to determine predictors of early and overall recurrence.Results: One hundred fifty-two patients (median age, 64 years; interquartile range, 56-72 years; 126 men) with 152 HCCs were evaluated. Twenty-six of the 152 HCCs (17%) were MTM-HCCs. LASSO-penalized logistic regression analysis identified sub-stantial necrosis, high serum alpha-fetoprotein (AFP) level (.100 ng/mL), and Barcelona Clinic Liver Cancer (BCLC) stage B or C as independent features associated with MTM-HCCs. At multivariable analysis, substantial necrosis (odds ratio = 32; 95% confidence interval [CI] = 8.9, 114; P < 001), high serum AFP level (odds ratio = 4.4; 95% CI = 1.3, 16; P =.02), and BCLC stage B or C (odds ratio = 4.2; 95% CI = 1.2, 15; P =.03) were independent predictors of MTM-HCC subtype. Substantial necrosis helped identify 65% (17 of 26; 95% CI: 44%, 83%) of MTM-HCCs (sensitivity) with a specificity of 93% (117 of 126; 95% CI: 87%, 97%). In adjusted models, only the presence of satellite nodules was independently associated with both early (hazard ratio = 3.7; 95% CI: 1.5, 9.4; P =.006) and overall (hazard ratio = 3.0; 95% CI: 1.3, 7.2; P =.01) tumor recurrence.Conclusion: At multiphase contrast-enhanced MRI, substantial necrosis helped identify macrotrabecular-massive hepatocellular carcinoma subtype with high specificity. (C) RSNA, 2020