Study On The Value Of Gd-EOB-DTPA Enhanced Magnetic Resonance Imaging In Screening And Quantitative Evaluation Of Hepatocellular Carcinoma

BackgroundPrimary liver cancer（PLC）is one of the most common malignant neoplasms in clinic,according to the latest literature data report,there are about 906,000 new cases each year worldwide,the incidence of malignant tumors ranked 6th in the world,the number of deaths per year is about 830,000,the death rate jumped to third place.Hepatocellular carcinoma（HCC）is the most common type of liver malignancy,about75%-85% of total cases,therefore,early screening of high-risk population for HCC and preoperative prediction of non-invasive histological grading of HCC patients were conducted,which is an important means for timely comprehensive treatment to improve the prognosis of patients,improve the overall survival rate and reduce the mortality of patients with hepatocellular carcinoma.Magnetic resonance imaging（MRI）has the advantages of non-radiation and non-invasive examination,the contrast and resolution of soft tissue are higher than other imaging examinations,it can accurately and clearly display the anatomical structure and morphological characteristics of normal liver parenchyma and part of the lesions.Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid（GD-Eob-DTPA）was used as liver-gallbladder specific contrast agent,it not only has the dynamic enhancement imaging function of conventional gadolinium agent,and can be taken by normal liver parenchyma cells to obtain a unique hepatobiliary specific stage,it can maximize the comparison shows that small lesions of hepatocellular carcinoma,MRI abbreviated sequence scanning with different combinations of liver-gallbladder specific contrast agents may be more conducive to the detection and early screening of HCC in high-risk population.Studies have found that OATP8 is an important molecular pathway involved in the uptake and transport of Gd-EOB-DTPA,different OATP8 expression levels may lead to different signal intensity of liver-biliary specific phase between normal background liver parenchyma cells and HCC tumor cells,the expression level of OATP8 decreased with the decrease of histological grade of hepatocellular carcinoma,therefore,different quantitative signal intensity values associated with hepatobiliary phase before and after enhanced scanning seem to be able to predict histological grade of HCC without invasive surgery,to provide more effective guidance for clinical selection of appropriate treatment to improve prognosis.From what has been discussed above,part of this study aimed to analyze the clinical value of different combinations of Gd-EOB-DTPA abbreviated MRI sequences in screening small liver cancer in high-risk population,to improve the detection rate of hepatocellular carcinoma in high-risk patients,a personalized MRI abbreviated sequence of Gd-EOB-DTPA abbreviated MRI was designed.The other part of the study was to predict the correlation and diagnostic efficacy of different signal intensities with Edmondson Steiner histological grading of hepatocellular carcinoma using quantitative indicators of different signal intensities before and after Gd-EOB-DTPA magnetic resonance imaging enhancement,which is helpful for early screening of hepatocellular carcinoma and preoperative histological grading prediction.Part Ⅰ Study on the value of Gd-EOB-DTPA MRI abbreviated sequence in screening small hepatocellular carcinoma in high-risk populationObjectiveTo compare the screening ability of three groups of abbreviated MR sequences for small hepatocellular carcinoma（small hepatocellular carcinoma,s HCC）in a highrisk population of hepatocellular carcinoma（HCC）.Materials and methodsThe images of 121 patients with pathological results who underwent full sequence gadoxetic acid–enhanced MR in Henan Provincial People’s Hospital from January 2017 to October 2020 were collected.Three groups of optimized sequences were extracted from the whole sequence for independent evaluation by two radiologists:（1）Non-contrast group,including T2 WI and DWI sequences.（2）Dynamic enhancement group,including mask and four-phase enhanced images of disodium gadolinium（early arterial phase,late arterial phase,portal venous phase,transitional phase）;（3）Hepatobiliary phase group,including T2 WI,DWI and20 min T1-HBP sequences.According to the pathological results,the patients were divided into positive or negative liver cancer,and the diagnostic efficiency of the abbreviated sequence in the three groups was calculated.ResultsThe scanning and preparation time of the three groups of abbreviated MRI sequences（minutes: seconds）are 12:52,13:04 and 14:06,respectively.The sensitivity and 95% confidence interval of the three abbreviated sequences for diagnosing small hepatocellular carcinoma were 85.5%（75%-92.8%）、91.35（82%-96.7%）、94.2%（85.8%-98.4%）,and the specificity was 73.1%（59%-84.4%）、90.4%（79%-96.8%）、88.5%（76.6%-95.6%）.The coincidence rate was80.2%（71.9%-86.9%）、90.9%（84.3%-95.4%）、91.7%（85.3%-96%）.The positive likelihood ratios of the three groups were 3.18,9.51,8.19,the negative likelihood ratios were 0.19,0.09,0.06,and the Youden index was 0.586,0.817 and 0.827 respectively.ConclusionsThe sensitivity of non-contrast group is higher,which is helpful for small hepatocellular carcinoma screening,while the specificity and coincidence rate of dynamic enhancement group and hepatobiliary phase group are higher,and the diagnostic efficacy of screening small hepatocellular carcinoma is better.Part Ⅱ The quantitative evaluation value of Edmondson Steiner histological grading of hepatocellular carcinoma by Gd-EOB-DTPA enhanced magnetic resonance imagingObjectiveThe relative signal intensity of hepatic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging analyzed by quantitative indicators to evaluate its predictive value of Edmondson Steiner histological grading of hepatocellular carcinoma.Materials and methodsClinical and pathological data were collected from 105 patients who underwent plain magnetic resonance imaging scan plus gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced scan due to liver space occupation in Henan Provincial People’s Hospital from January 2017 to December 2021,according to Edmondson Steiner tumor classification and diagnostic criteria,there were 13 cases of grade I,61 cases of grade II,26 cases of grade III,and 5 cases of grade IV.The signal intensity of hepatocellular carcinoma lesion and background liver before and after enhancement was measured.Absolute contrast enhancement,tumor-tumor contrast enhancement rate,tumor-liver contrast enhancement rate,relative intensity ratio and enhancement rate were calculated.One-way ANOVA was used to compare the differences of five relative signal intensity parameters between different Edmondson Steiner grades of liver cancer.Receiver operating characteristic（ROC）curves were drawn to evaluate the diagnostic efficacy of five relative signal intensity parameters for histological grading of hepatocellular carcinoma.Delong test was used to compare the area under ROC curve（AUC）of each group.ResultsThere were statistically significant differences in absolute contrast enhancement（P < 0.001）,tumor-tumor contrast enhancement rate（P=0.008）,tumor-liver contrast enhancement rate（P=0.022）and enhancement rate（P=0.015）among patients with HCC with different Edmondson Steiner grade lesions,,there was no significant difference in the relative intensity ratio（P=0.184）between different Edmondson Steiner grading groups.Spearman correlation analysis showed that absolute contrast enhancement was significantly positively correlated with differentiation degree of hepatocellular carcinoma（r=0.629,P<0.001）,tumor-tumor contrast enhancement rate（r=0.330,P<0.01）,tumor-liver contrast enhancement rate（r=0.221,P<0.05）,relative strength ratio（r=0.200,P<0.05）and strengthening rate（r=0.310,P<0.01）were significantly weakly positively correlated.Absolute contrast enhancement in the diagnosis of hepatocellular carcinoma showed the largest area under the curve（AUC）（0.822）with different Edmondson Steiner grades,indicating the highest diagnostic efficiency.ConclusionsIn patients with Child-Pugh A or B liver function,some quantitative indicators of hepatic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging have certain value in predicting Edmondson Steiner histological grade of HCC,and absolute contrast enhancement is the most relevant and diagnostic indicator.Part Ⅲ Meta-analysis of the value of abbreviated magnetic resonance sequence in hepatocellular carcinoma screeningObjectiveTo systematically evaluate the diagnostic efficacy of abbreviated magnetic resonance imaging sequence screening for hepatocellular carcinoma（HCC）in high-risk population.Materials and methodsWe searched the Embase,Pub Med,Cochrane Library,Web of Science,CNKI,Wanfang,and VIP databases for the English and Chinese literatures about abbreviated magnetic resonance imaging sequence（AMRI）screening for hepatocellular carcinoma（HCC）,and selected the value of AMRI screening for HCC according to the inclusion and exclusion criteria..The retrieval time was from construction to July30,2021.QUADAS-2 quality evaluation scale was used to evaluate the quality of the included literature.Stata 16.0 software was used to analyze the combined sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and combined diagnostic odds ratio of the included studies.Forest plots and summary receiver operating characteristics（SROC）curves were plotted and the area under the SROC curve（AUC）was calculated.The heterogeneity between studies was evaluated with Higgins I2 and Cochrane Q.Meta-regression was used to explore the source of heterogeneity.Deek’s diagram was drawn to evaluate whether publication bias existed.Fagan diagram was drawn to evaluate the clinical application value of diagnostic tests.ResultsA total of 14 literatures were included,including 2758 lesions from 2702 patients.Total AMRI combined sensitivity and specificity were 85%（83%-87%）92%（90%-94%）,respectively.In classification studies,the combined sensitivity and specificity of NC AMRI and HBP AMRI were 84%（81-88%）91%（87%-94%）and87%（83%-90%）93%（92-95%）,respectively,the combination sensitivity and specificity of the two schemes were comparable to some extent.Further analysis showed that the combined sensitivity and specificity of T2+DWI+HBP in HBP AMRI were 86%（81-91%）and 94%（91-95%）,respectively,and AUC was 0.96,indicating the highest diagnostic efficacy.The total AMRI showed moderate or above heterogeneity,and meta-regression analysis showed that whether the population was cirrhotic or not was an important factor affecting the heterogeneity of the study（P<0.05）.The Deek’s diagram indicates that there is no significant publication bias among the different abbreviated sequence schemes included in the study（P>0.05）.The Fagan diagram suggests that T2+DWI+HBP has a better diagnostic effect as a confirmation test.ConclusionsAll AMRI protocols have acceptable sensitivity and specificity for HCC screening.Among them,T2+DWI+HBP protocol showed the highest diagnostic efficiency when used as abbreviated magnetic resonance imaging sequence for screening hepatocellular carcinoma,the screening process can be optimized while improving the accuracy of screening.Due to limited quantity and quality of the included studies,the above conclusions are required to be verified by more high-quality studies.