| Objective To explore the application value of Gd-EOB-DTPA-enhanced magnetic resonance imaging combined with AFP and other serological indicators in the diagnosis of sHCCMethods1.From December 2015 to September 2017,Gd-EOB-DTPA-enhanced MRI was admitted to the first affiliated hospital of soochow university.According to the inclusion and exclusion criteria,236 patients were selected.124 patients with sHCC were included in the liver cancer group,and 112 patients without sHCC were included in the control group.Blood routine examination,biochemical whole set,blood coagulation routine examination and AFP examination results within one week before and after MRI examination were collected for all the selected patients.All patients received Gd-EOB-DTPA-enhanced MRI,and the results of Gd-EOB-DTPA-enhanced MRI were transmitted to system PACS for data processing,and analyzed by two radiologists with 10 years of experience in liver MRI reading without knowing any relevant clinical information.The data of normal distribution were represented by average±standard deviation,and pairwise comparison was conducted by t test.The measurement data of skewed distribution were expressed as[M(Q1,Q3)],and mann-whitney U rank sum test was used for comparison between groups.Expressed in frequency count data,group comparison between the chi-squaretest or Fisher’s exact test.Univariate analysis showed significance and then multivariate analysis was conducted,and binary Logistic analysis was used to determine the final influencing factors.AUC was used to evaluate the sensitivity and specificity of each influencing factor and joint detection and diagnosis.2.Data of patients with liver disease admitted to the first affiliated hospital of soochow university from December 2015 to September 2017 were collected,and a total of 82 cases were left after inclusion and exclusion criteria screening.Among them,56 cases of patients diagnosed with hepatocellular carcinoma(HCC)were defined as the liver cancer group,and 26 cases of patients without HCC were defined as the control group.Collect all the cases of MRI before and after a week of AFP and PIVKA-Ⅱ test results.All patients received Gd-EOB-DTPA enhanced MRI examination,and the MRI results were transmitted to the PACS system for data processing,and analyzed by two radiologists with 10 years of experience in liver MRI reading without knowing any relevant clinical information.The mann-Whitney U rank and inspection comparison between different groups of AFP and PIVKA-II level.Adopts the chi-square test or Fisher ’s accurate inspection Gd-EOB-DTPA enhancement MRI in the diagnosis efficiency between different groups AUC was used to evaluate the sensitivity and specificity of each influencing factor and joint detection and diagnosis.Results1.1 PLT in serum of sHCC patients was(128.2 ± 76.0)*109/L,significantly lower than that of the control group[(164.9±86.9)*109/L,P=0.001].The serum AFP of sHCC patients was 8.8(2.9,108.4)ng/ml,significantly higher than that of the control group[3.5(2.2,8.4)ng/ml,P<0.001].1.2 The results of Gd-EOB-DTPA enhanced MRI showed differences in arterial hyperintensity,hepatobiliary hyperintensity and diffusion-weighted imaging hyperintensity between sHCC patients and the control group(P<0.05).1.3 In order to diagnose sHCC,the optimal clinical cutoff points of serum PLT and AFP were 158.5*109/L and 4.8 ng/ml.At this time,the sensitivity and specificity of the diagnosis of sHCC were 63.7%,65.2%,75.0%and 51.8%.1,4 The sensitivity and specificity of high signal in arterial phase,low signal in hepatobiliary phase and high signal in diffusion-weighted imaging in the enhanced MRI results of Gd-EOB-DTPA in the diagnosis of sHCC were 75%,50%,71.0%,59.8%,75.8%and 57.1%.1.5 Combined test Ⅱ and combined test Ⅲ can increase the sensitivity and specificity of HCC diagnosis to 62.9%and 96.43%,and the combined application of multiple diagnostic methods can improve the actual diagnostic efficiency of sHCC.2.1 HCC patients AFP and PIVKA,Ⅱ level were 34.5 ng/ml(4,5,594.9)and 63.5(25.0,2082.0)Mau/ml,significantly higher than the comparison way[3.4(2.2,11.6)ng/ml and 23.0(18.8,28.0)Mau/ml,P<0.01];2.2 The area under ROC curve of serum AFP,PIVKA-Ⅱ levels and MRI in diagnosing HCC were 0.763,0.815,and 0.907,respectively;2.3 When single diagnosis of HCC,AFP and PIVKA-the best clinical diagnosis Ⅱtruncation point respectively Mau/ml,14.4 ng/ml and 40.5 degree of sensitivity,specific and accuracy of the diagnosis of HCC were 64.3%,84.6%,70.7%and 62.5%respectively,100.0%,74.4%,Gd-EOB-DTPA enhanced the sensitivity of MRI in the diagnosis of HCC separately,specific degrees and accuracy were 92.9%,88.5%,91.5%,Enhanced MRI with Gd-EOB-DTPA has the highest diagnostic efficiency.2.4 Joint test Ⅰ diagnosis of HCC,the sensitivity was 98.2%,73.1%,the joint test Ⅱdiagnosis of HCC sensitivity of 46.4%,100.0%.The combined test increased diagnostic specificity but decreased sensitivity.Conclusion1.AFP and high signal in arterial phase,low signal in hepatobiliary specific phase and high signal in DWI of Gd-EOB-DTPA-enhanced MRI were significant for the diagnosis of sHCC.Combined diagnosis can significantly improve the diagnostic efficiency of sHCC.2.The combination of serum AFP and PIVKA-Ⅱ detection and MRI in diagnosis of patients with HCC is efficacious,and the early diagnosis might be hard at present,which should be investigated in the future. |
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