Diagnosis Study Of Microvascular Invasion In Hepatocellular Carcinoma By Preoperative Ultrasound And MRI

Objective: To investigate the value of hepatic hemodynamics in diagnostic microvascular invasion(MVI)of hepatocellular carcinoma(HCC),and to analyze the diagnostic efficacy of preoperative ultrasonography,magnetic resonance imaging(MRI)and ultrasound combined with MRI for HCC MVI.Methods: A total of 53 HCC patients newly diagnosed in our hospital from September 2019 to October 2021 were enrolled,including 31 patients who underwent preoperative ultrasound examination,48 patients who underwent preoperative MRI examination,and 26 patients who underwent preoperative ultrasound and MRI examination simultaneously.Using postoperative pathology as the gold standard,the patients were divided into the MVI positive group and the MVI negative group.By analyzing the differences of ultrasound and MRI signs between the two groups,the diagnostic efficacy of preoperative ultrasound,MRI and ultrasound combined with MRI for HCC MVI was discussed.Results: 1.There were statistically significant differences in the tumor size,incomplete/absent capsule,hepatic artery EDV,hepatic artery PI,hepatic artery RI and hepatic artery S/D values between the two groups(all P<0.05),which were high-risk signs of MVI.The threshold values of tumor size,hepatic artery EDV,hepatic artery PI,hepatic artery RI and hepatic artery S/D were 4.9cm,18.275 cm/ s,1.285,0.685 and 3.20 respectively.The diagnostic efficiency of HCC MVI was the highest when there were any three high risk signs ultrasonographic signs(sensitivity 78.95%,specificity 91.67%,accuracy83.87%).2.There were statistically significant differences in MRI images between the two groups in the tumor size,incomplete/absent capsule,non-smooth edge and peritumoral low signal in hepatobiliary stage(all P<0.05),which were high-risk signs of MVI.The threshold of tumor size was 6.0cm.MRI non-smooth edge signs had the highest diagnostic efficiency for HCC MVI(sensitivity 82.14%,specificity 70.00%,accuracy 77.08%).3.The sensitivity,specificity and accuracy of any three high-risk ultrasound signs combined with MRI non-smooth edge signs in diagnosing MVI were 93.33%,54.55% and76.92%,respectively.Conclusions: 1.Hepatic artery EDV≥18.275 cm/s,hepatic artery PI≤1.285,hepatic artery RI≤0.685,and hepatic artery S/D≤3.20 can be used as reference values for early identification of MVI after HCC operation.2.Ultrasonographic signs of tumor size,incomplete/absent capsule,hepatic artery EDV,hepatic artery PI,hepatic artery RI,and hepatic artery S/D are high-risk signs of MVI,and the existence of any three high-risk signs has the highest diagnostic efficiency for HCC MVI.3.MRI signs such as tumor size,incomplete/absent capsule,non-smooth edge and low peritumoral signal at hepatobiliary stage were high-risk signs of MVI,and non-smooth edge had the highest diagnostic efficiency for HCC MVI.4.The sensitivity of any three ultrasound high-risk signs combined with MRI non-smooth edge signs in diagnostic HCC MVI is significantly higher than that of ultrasound and MRI alone.