Clinical Study Of Gd-EOB-DTPA Dynamic Enhanced MRI And IVIM-DWI In Predicting Microvascular Invasion Of Hepatocellular Carcinoma

Objective:To investigate the imaging features of Gd-EOB-DTPA dynamic contrast-enhanced MRI and the value of MR diffusion-weighted imaging with incoherent voxel motion(IVIM-DWI)in predicting microvascular invasion of hepatocellular carcinoma(MVI)before operation,and to evaluate the feasibility of its clinical application.Materials and methods:From January 2018 to November 2019,128 patients with suspected HCC were treated in our hospital(judged by their clinical manifestations,biochemical indexes and related imaging examinations).Each patient underwent Gd-EOB-DTPA dynamic enhanced MRI and IVIM-DWI imaging of the upper abdomen.Inclusion criteria:?No liver or spleen surgery or related interventional therapy was performed before MRI;?No macrovascular invasion was detected in MR imaging,that is,no tumor thrombus invasion of major branches such as portal vein,hepatic vein and inferior vena cava;?IVIM-DWI imaging and Gd-EOB-DTPA enhanced MRI were performed before operation,and the interval between examination and operation was less than 1 week;?No other anti-tumor therapy or invasive examination was performed before operation;?The quality of IVIM-DWI sequence images and Gd-EOB-DTPA enhanced images examined by MRI is good enough to satisfy the related graphic analysis;?The histopathology proved to be HCC after operation;?There was no known extrahepatic metastasis.Exclusion criteria:?Malignant tumors with other organs or systems;?Postoperative histopathology of non-HCC patients or unoperated patients;?HCC patients with a diameter smaller than 1cm;?And the time interval between MR imaging and operation was more than one week.Finally,according to the following inclusion criteria,this study included 50 patients for statistical analysis,including 41 male patients and 9 female patients,aged between 25 and 80 years old,with an average age of 54.7 years.MRI examinations of all patients were performed on 3.0-TMR(Ingenia,Philips,Netherlands)system with 16-channel phased array coils.The scanning sequences included:axial mDixon,T2WI,liver DWI,IVIM,Gd-EOB-DTPA enhanced arterial phase,portal vein phase,balance phase and hepatobiliary phase were scanned after localization by three-dimensional method..The imaging features of Gd-EOB-DTPA dynamic contrast-enhanced MRI in 50 patients were observed and analyzed,including enhancement around tumor in arterial phase,unsmooth edge of tumor,enhancement around tumor in hepatobiliary phase and tumor diameter.IVIM-DWI parameters D,D*,f and ADC were measured by IMAge/engine software.The choice of statistical method is that chi-square test is used for counting data,and its diagnostic efficiency is calculated.Independent sample t-test is used for measurement data,and Spearman correlation analysis is used to analyze its correlation with the occurrence of MVI.Finally,ROC curve is used to compare the diagnostic efficiency of measurement data with statistical significance for predicting the occurrence of MVI.Results:Among the 50 cases,13 cases were confirmed by pathology to have MVI,37 cases had no MVI.In the counting data of Gd-EOB-DTPA dynamic enhanced MRI imaging features,arterial phase peritumoral enhancement,tumor marginal morphology and hepatobiliary phase peritumoral low signal intensity were significantly different in predicting the presence or absence of MVI(P<0.001,0.006,<0.001,respectively).Among them,arterial peritumor enhancement was the best in predicting MVI,with a sensitivity of 92.3%and a specificity of 78.4%.IVIM-DWI parameter D value,ADC value and tumor diameter had statistical significance in predicting MVI(P=O.009,0.010,0.021),while IVIM-DWI parameter f and value D*had no significant difference in predicting MVI(P=O.355,0.605).There was a negative correlation between IVIM-DWI parameter D and the occurrence of MVI,while there was a positive correlation between tumor diameter and the occurrence of MVI.Finally,through the analysis of ROC curve,it is concluded that the diagnostic efficiency of D value is the best(AUC=0.740)when the measurement parameters are used to predict the occurrence of MVI.Conclusion:Gd-EOB-DTPA dynamic enhanced MRI imaging features(arterial phase peritumoral enhancement,tumor marginal morphology,hepatobiliary peritumoral low signal intensity and tumor diameter)and IVIM-DWI parameter D value and ADC value can predict MVI,before operation,and arterial peritumor enhancement and IVIM-DWI parameter D value are the best in predicting MVI,and the IVIM-DWI parameter D value is negatively correlated with the occurrence of MVI,while the tumor diameter is positively correlated with the occurrence of MVI.