Predictive Value Of Preoperative Ki-67 Combined With Multimodal Ultrasonography Based On Micro Flow Imaging In Microvascular Invasion Of Hepatocellular Carcinoma

Objective:To evaluate the value of preoperative Ki-67 combined with multimodal ultrasound based on micro flow imaging(MFI)in predicting microvascular invasion(MVI)of hepato cellular carcinoma(HCC).Methods:The patients with HCC who underwent radical hepatectomy,two-dimensional ultrasound(2D-US),contrast-enhanced ultrasound(CEUS),MFI and ultrasound-guided liver tumor biopsy in our hospital from January 2019 to May 2022 were analyzed retrospectively.The clinical,imaging and pathological data of all patients were collected,including sex,age,history of hepatitis,2D-US,two-dimensional micro flow imaging(2D-MFI)features,CEUS,contrast-enhanced ultrasound micro flow imaging(CEUS-MFI),histopathological data and immunohistochemical data.According to the gold standard of pathology after hepatectomy,the patients were divided into MVI positive group and MVI negative group.In the univariate analysis of this study,T-test and Rank-sum test are used to compare measurement data between two groups;Chi-squared test is used to compare counting data between two groups.The variables with statistical differences in univariate analysis is included in multivariate Logistic regre ssion analysis to determine the independent predictors of MVI positivity.Receive operating characteristic(ROC)curve is made and the area under the curve(AUC)is calculated.The predictive value of preoperative Ki-67,2D-US based on MFI,CEUS based on M FI and preoperative Ki-67 combined with multimodal ultrasound in predicting MVI are analyzed.P<0.05 indicates that the difference is statistically significant.Results:80 patients were divided into MVI positive group(n=39)and MVI negative group(n=41).The results of univariate analysis showed that there were significant differences in preoperative Ki-67 between the two groups(P<0.001),and there were significant differences in the number of nodules,boundary of nodules,shape of nodules,2D-MFI vascular classification and distribution between the two groups in 2D-US based on MFI(P<0.05).The results of univariate analysis showed that,in CEUS based on MFI,there were significant differences in extension of enhancement range,enhancement mode at arteri al phase,shape of nodules at arterial phase,chaotic blood vessels in arterial phase,time to washout,clearance degree at portal phase and CEUS-MFI between the two groups(P<0.05).After binary Logistic regression analysis,it was found that in the 2D-US based on MFI,the number of nodules and the boundary of nodules are independent predictors for the occurrence of MVI positive before operation(P<0.05).In CEUS based on MFI,the extension of enhancement range,time to washout and CEUS-MFI were independent predictors of positive MVI before operation(P<0.05).ROC curve showed that the AUC of preoperative Ki-67 combined with multimodal ultrasound based on MFI were higher than preoperative Ki-67 and single mode ultrasound(P<0.001).Conclusion:Preoperative Ki-67 combined with multimodal ultrasound based on MFI was feasible for the prediction of MVI in HCC,and it was more effective than single modality(preoperative Ki-67,2D-US based on MFI,CEUS based on MFI)was more accurate and comprehensive.