| Objective: To investigate the clinical value of gadolinium-ethoxybenzyldiethylenetriaminepentaaceticacid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)in the preoperative diagnosis of macrotrabecular-massive hepatocellular carcinoma(MTM-HCC).Methods: The clinicopathological data and follow-up result of 150 HCC patients who were admitted to the First Affiliated Hospital of Army Medical University from January2019 to December 2020 were collected,the follow-up was discontinued when the recurrence criteria were reached,follow-up deadline was 1th,November 2021.There were 116 males and 34 females,aged(53±10)years.There were 38 MTM-HCC patients and 112 non-macrotrabecular-massive hepatocellular carcinoma(n MTM-HCC)patients.55 patients were positive for microvascular invasion(MVI).All patients received upper abdominal enhanced CT examination and Gd-EOB-DTPA enhanced MRI.The clinical data,biochemical examination.The recurrence time of MTM-HCC and n MTM-HCC after resection was recorded,and the survival time curve of the two groups was analyzed by Kaplan-Meier method.The Chi-square test was also applied in counting data,and an independent sample t-test or Mann-Whitney U test was used to analysis of index between MTM-HCC and n MTM-HCC.Logistic regression statistics analysis was used to screen out independent predictors for diagnosing MTM-HCC.ROC curve was archived to evaluate the diagnostic efficiency of MRI and CT in MTM-HCC.Results:(1)AFP value of 38 MTM - HCC patients and 112 n MTM - HCC patients was329(20,1034)μg/L and 25(8,200)μg/L,the difference was statistically significant(Z =-3.306,P < 0.05).The number of MVI-positive in MTM-HCC 38 patients and 112 n MTM-HCC patients were 24 and 31,respectively,and the difference was statistically significant(χ~2 = 15.380,P < 0.05).(2)The median recurrence free survival rate of 29MTM-HCC patients and 85 n MTM-HCC patients was 196 [109,333] and 252 [126,316]days,respectively,and the survival time curve analysis showed a statistically significant difference(P < 0.05).(3)Gd-EOB-DTPA enhanced MRI showed that cases with regular morphology of tumor,intratumor fat-free,arterial phase peritumoral enhancement,complete capsule,intratumor necrosis or ischemia,peritumoral hypointense at hepatobiliary phase were significantly different in MTM-HCC and n MTM-HCC(χ~2 =7.049,8.684,16.399,8.303,31.368,22.783,P < 0.05).Logistic regression analysis showed that intratumor fat-free,intratumor necrosis or ischemia were independent predictors for MTM-HCC(hazard ratio = 4.033,0.215,95% confidence interval as1.196～13.603,0.079～0.588,P < 0.05).(4)Enhanced CT showed that cases with regular morphology of tumor,arterial phase peritumoral enhancement,complete capsule,intratumor necrosis or ischemia were significantly different in MTM-HCC and n MTMHCC(χ~2 = 7.049,8.201,16.399,8.303,23.218,P < 0.05).Logistic regression analysis showed that intratumor necrosis or ischemia were independent predictors for MTM-HCC(hazard ratio = 0.194,95% confidence interval as 0.084～0.453,P < 0.05).(5)With GdEOB-DTPA enhanced MRI examination,the area under ROC,sensitivity and specificity of intratumor fat-free combined with intratumor necrosis or ischemia for diagnosis of MTM-HCC were 0.799,73.7%,76.8%,and with CT examination,the above indicators of intratumor necrosis or ischemia for diagnosis of MTM-HCC were 0.717,68.4%,75.0%Conclusion:(1)Compared to n MTM-HCC,MTM-HCC has a higher level of AFP,MVI positive,and poor prognosis.(2)Intratumor fat-free,intratumor necrosis or ischemia on Gd-EOB-DTPA MRI are independent predictors for MTM-HCC.The two combined features have higher diagnostic efficacy than CT.Gd-EOB-DTPA enhanced MRI can be helpful for preoperative diagnosis of MTM-HCC. |
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