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中华消化病与影像杂志(电子版) ›› 2025, Vol. 15 ›› Issue (04) : 317 -325. doi: 10.3877/cma.j.issn.2095-2015.2025.04.006

论著

钆塞酸二钠增强MRI多模态参数与原发性肝癌患者病情程度的相关性研究
何源青1, 郭雷明1,†(), 冯佩1, 马春宁1, 岳欣2   
  1. 1712000　陕西省，咸阳市中心医院医学影像中心
    2712000　陕西咸阳，西藏民族大学附属医院影像科
  • 收稿日期:2024-10-11 出版日期:2025-08-01
  • 通信作者: 郭雷明

Correlation study between multimodal parameters of gadoxetic acid disodium enhanced MRI and disease severity in patients with primary hepatocellular carcinoma

Yuanqing He1, Leiming Guo1,†(), Pei Feng1, Chunning Ma1, Xin Yue2   

  1. 1Medical Imaging Center, Xianyang Central Hospital, Xianyang 712000, China
    2Department of Imaging, Affiliated Hospital of Xizang Minzu University, Xianyang 712000, China
  • Received:2024-10-11 Published:2025-08-01
  • Corresponding author: Leiming Guo
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引用本文：

何源青, 郭雷明, 冯佩, 马春宁, 岳欣. 钆塞酸二钠增强MRI多模态参数与原发性肝癌患者病情程度的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(04): 317-325.

Yuanqing He, Leiming Guo, Pei Feng, Chunning Ma, Xin Yue. Correlation study between multimodal parameters of gadoxetic acid disodium enhanced MRI and disease severity in patients with primary hepatocellular carcinoma[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(04): 317-325.

目的

分析钆塞酸二钠注射液（普美显）增强MRI多模态参数与原发性肝癌患者病情程度的相关性。

方法

纳入咸阳市中心医院2021年10月至2022年10月收治的90例原发性肝癌患者为研究对象，所有患者均接受普美显增强MRI检查，并进行肝功能Child-Pugh分级、病情分级、血管浸润及预后质量评估，比较MRI多模态定量参数[表现弥散系数（ADC）、真实扩散系数（D）、灌注相关扩散系数（D*）、灌注分数（f）、速率常数（Kep）、容积转移常数（Ktrans）、血管外细胞外间隙体积百分比（Ve）]与患者病情程度（肝功能、病情分级、血管浸润、预后质量）的相关性。

结果

不同肝功能Child-Pugh分级、病情分期患者的ADC、D、D*、f、Kep、Ktrans、Ve比较，差异均有统计学意义（P<0.05）。无浸润组患者ADC、D高于血管浸润组，D*、f、Ktrans、Kep、Ve高于血管浸润组（P<0.05）。预后良好组患者ADC、D高于预后不良组，D*、f、Ktrans、Kep、Ve高于预后不良组，其中死亡组ADC、D低于生存组，D*、f、Ktrans、Kep、Ve高于生存组（P<0.05）。Sprearman模型分析ADC、D值与肝功能分级、病情分期、血管浸润、预后质量呈负相关（P<0.05），D*、f、Kep、Ve值与之呈正相关（P<0.05）。Logistic多因素回归分析显示，ADC<1.6×10-3 mm2/s、D<1.45×10-3 mm2/s、D*≥59×10-3 mm2/s、f≥25%、Kep≥1.35/min、Ktrans≥0.41/min、Ve≥0.36均为影响原发性肝癌患者预后不良的危险因素（P<0.05）。联合ADC、D、D*、f、Kep、Ktrans、Ve预测原发性肝癌患者预后不良的AUC为0.936，灵敏度、特异性为91.89%、89.69%（P<0.05）。

结论

普美显增强MRI多模态定量参数与患者肝功能、病情分级、血管浸润、预后质量具有密切相关性，有助于患者病情评估，且为患者预后预测提供更可靠的影像学参考依据。

关键词: 肝癌, 肝功能, 磁共振成像, 钆塞酸二钠, 病情分级, 预后
Objective

To analyze the correlation between multimodal parameters of gadoxetic acid disodium (Primovist) enhanced MRI and the severity of primary hepatocellular carcinoma in patients.

Methods

A total of 90 patients with primary hepatocellular carcinoma admitted to Xianyang Central Hospital from October 2021 to October 2022 were included as the study subjects, all patients underwent Primovist enhanced MRI examination and underwent Child Pugh grading of liver function, disease grading, vascular infiltration, and prognosis quality evaluation, and the correlation between MRI multimodal quantitative parameters [apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion related diffusion coefficient (D*), perfusion fraction (f), rate constant (Kep), volume transfer constant (Ktrans), and percentage of extracellular space volume (Ve)] and patient disease severity (liver function, disease grading, vascular infiltration, prognosis quality) was analyzed.

Results

There were statistically significant differences in ADC, D, D*, f, Kep, Ktrans and Ve among patients with different Child-Pugh grades of liver function and disease stages (P<0.05). ADC and D in the non-invasive group were higher than those in the vascular invasion group, and D*, f, Ktrans, Kep and Ve were higher than those in the vascular invasion group (P<0.05). ADC and D in the good prognosis group were higher than those in the poor prognosis group; D*, f, Ktrans, Kep, Ve were higher than those in the poor prognosis group; ADC and D in the death group were lower than those in the survival group; D*, f, Ktrans, Kep, Ve were higher than those in the survival group (P<0.05). According to Spearman model, ADC and D values were negatively correlated with liver function grade, disease stage, vascular infiltration and prognostic quality (P<0.05), while D*, f, Kep and Ve values were positively correlated with them (P<0.05). Logistic multivariate regression analysis showed that ADC<1.6×10-3 mm2/s, D<1.45×10-3 mm2/s, D*≥59×10-3 mm2/s, f≥25%, Kep≥1.35/min, Ktrans≥0.41/min, Ve≥0.36 were all risk factors affecting poor prognosis of patients with primary hepatocellular carcinoma (P<0.05). Combined ADC, D, D*, f, Kep, Ktrans and Ve predicted the AUC of poor prognosis in patients with primary hepatocellular carcinoma was 0.936, and the sensitivity and specificity were 91.89% and 89.69% (P<0.05).

Conclusion

The multimodal quantitative parameters of Primovist-enhanced MRI exhibits a significant correlation with liver function, disease grading, vascular invasion, and quality of prognosis in patients, these parameters are instrumental in assessing the severity of the disease and provide a more reliable imaging reference for predicting patient prognosis.

Key words: Hepatocellular carcinoma, Liver function, Enhanced magnetic resonance, Disodium gadoxetic acid, Disease classification, Prognosis
图1 原发性肝癌患者，男，51岁，临床分期Ⅰ期，肝功能分级Child-Pugh A级。MRI增强图像：肝7~8段交界处占位。1A动脉期，1B静脉期，1C延迟期，1D普美显肝胆期，1E轴位扩散加权成像，1F表现弥散系数
图2 原发性肝癌患者，男，72岁，临床分期Ⅱ期，肝功能分级Child-Pugh B级。MRI增强图像肝5~6段多发占位。2A动脉期，2B静脉期，2C延迟期，2D普美显肝胆期，2E轴位扩散加权成像，2F表现弥散系数
图3 原发性肝癌患者，男，54岁，临床分期Ⅲ期，肝功能分级Child-Pugh B级。MRI增强图像肝2~3段多发占位。3A动脉期，3B静脉期，3C延迟期，3D普美显肝胆期，3E轴位扩散加权成像，3F表现弥散系数
图4 原发性肝癌患者，男，54岁，临床分期Ⅳ期，肝功能分级Child-Pugh C级。MRI增强图像：肝右叶多发占位并侵犯动静脉。4A动脉期，4B静脉期，4C延迟期，4D普美显肝胆期，4E轴位扩散加权成像，4F表现弥散系数
表1 不同肝功能Child-Pugh分级肝癌患者的普美显增强MRI多模态参数比较（ ± s）
参数 A级(n=28) B级(n=42) C级(n=20) t值 P值
ADC(×10-3mm2/s) 1.64±1.02 1.35±0.57 1.24±0.42 15.654 <0.001
D(×10-3mm2/s) 1.46±0.74 1.24±0.52 1.06±0.14 11.080 <0.001
D*(×10-3mm2/s) 61.34±5.21 65.54±6.36 71.34±6.21 12.807 <0.001
f(%) 28.24±3.42 32.85±3.57 35.24±4.42 18.165 <0.001
Kep/min 0.66±0.33 0.84±0.12 1.26±0.64 12.867 <0.001
Ktrans/min 0.36±0.04 0.44±0.02 0.66±0.04 14.869 <0.001
Ve 0.66±0.14 0.44±0.12 0.36±0.04 16.587 <0.001
表2 不同病情分期肝癌患者的普美显增强MRI多模态参数比较（ ± s）
参数 Ⅰ期(n=33) Ⅱ期(n=23) Ⅲ期(n=22) Ⅳ期(n=12) t值 P值
ADC(×10-3mm2/s) 1.65±1.13 1.37±0.59 1.25±0.42 0.64±0.13 14.578 <0.001
D(×10-3mm2/s) 1.45±0.55 1.26±0.49 1.05±0.44 0.84±0.74 11.080 <0.001
D*(×10-3mm2/s) 66.34±5.30 65.55±6.39 71.34±6.63 81.35±5.20 12.807 <0.001
f(%) 26.24±3.34 32.65±3.58 35.56±4.42 38.23±3.55 18.165 <0.001
Kep/min 0.64±0.37 0.88±0.16 1.36±0.56 1.67±0.33 12.867 <0.001
Ktrans/min 0.35±0.06 0.42±0.14 0.67±0.12 1.36±0.24 14.869 <0.001
Ve 0.63±0.11 0.47±0.20 0.35±0.04 0.13±0.05 16.587 <0.001
表3 血管浸润与无浸润肝癌患者普美显增强MRI多模态参数比较（ ± s）
参数 无浸润组(n=38) 浸润组(n=52) t值 P值
ADC(×10-3mm2/s) 1.64±1.15 1.25±0.42 16.607 <0.001
D(×10-3mm2/s) 1.45±0.55 1.05±0.57 11.230 0.960
D*(×10-3mm2/s) 66.34±5.58 71.34±6.63 16.654  
f(%) 26.27±3.54 35.57±4.42 28.165 <0.001
Kep/min 0.65±0.38 1.40±0.67 16.750  
Ktrans/min 0.35±0.27 0.67±0.31 16.804  
Ve 0.63±0.16 0.35±0.30 18.868 <0.001
表4 不同预后质量肝癌患者的普美显增强MRI多模态参数比较（ ± s）
基线资料 预后良好组(n=36) 预后不良组(n=54) t值 P值
生存组(n=31) 死亡组(n=13)
ADC(×10-3mm2/s) 1.77±1.13 1.26±0.42 0.64±0.15 11.164 <0.001
D(×10-3mm2/s) 1.56±0.55 1.05±0.44 0.84±0.75 24.780 <0.001
D*(×10-3mm2/s) 54.36±5.32 71.36±6.63 82.45±5.24 24.079 <0.001
f(%) 20.57±3.34 36.54±4.42 39.23±3.55 28.641 <0.001
Ktrans/min 0.34±0.07 0.67±0.11 0.75±0.30 22.553 <0.001
Kep/min 0.47±0.33 1.36±0.56 1.68±0.33 23.386 <0.001
Ve 0.74±0.07 0.68±0.10 1.38±0.26 28.867 <0.001
表5 普美显增强MRI多模态参数与肝癌患者病情程度的相关性
病情程度 ADC D D* f Kep/min Ktrans/min Ve
肝功能分级 r -0.452 -0.532 0.443 0.452 0.652 0.550 0.561
P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
病情分期 r -0.462 -0.546 0.472 0.479 0.640 0.566 0.548
P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
血管浸润 r -0.552 -0.560 0.480 0.468 0.628 0.538 0.549
P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
预后质量 r -0.573 -0.562 0.483 0.459 0.643 0.529 0.546
P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
表6 多因素回归分析赋值表
变量名 变量 赋值
Y 预后质量 预后良好=0，预后不良=1
X1 ADC ≥1.6×10-3mm2/s=0，<1.6×10-3mm2/s=1
X2 D ≥1.45×10-3mm2/s=0，<1.45×10-3mm2/s=1
X3 D* <59×10-3mm2/s=0，≥59×10-3mm2/s=1
X4 f <25%=0，≥25%=1
X5 Kep <1.35/min=0，≥1.35/min=1
X6 Ktrans <0.41/min=0，≥0.41/min=1
X7 Ve <0.36=0，≥0.36=1
表7 MRI多模态参数对原发性肝癌患者预后预测的多因素回归分析结果
影响因素 β SE(β) Wald χ2值 P值 OR 95% CI
ADC 1.556 0.354 19.320 <0.001 4.740 2.368~9.486
D 1.365 0.397 11.822 0.001 3.916 1.798~8.526
D* 1.359 0.376 13.064 <0.001 3.892 1.863~8.133
f 1.256 0.315 15.899 <0.001 3.511 1.894~6.510
Kep 1.312 0.324 16.398 <0.001 3.714 1.968~7.008
Ktrans 1.413 0.387 13.331 <0.001 4.108 1.924~8.772
Ve 1.383 0.368 14.124 <0.001 3.987 1.938~9.201
图5 MRI多模态参数对原发性肝癌患者预后预测ROC曲线分析注：ADC表现弥散系数；D真实扩散系数；D*灌注相关扩散系数；f灌注分数；Kep速率常数；Ktrans容积转移常数；Ve血管外细胞外间隙体积百分比
表8 MRI多模态参数对原发性肝癌患者预后预测效能分析
危险因素 截断值 AUC 95% CI 灵敏度(%) 特异性(%)
ADC 1.6×10-3mm2/s 0.752 0.451~0.802 71.59 64.68
D 1.45×10-3mm2/s 0.742 0.513~0.875 68.89 67.63
D* 59×10-3mm2/s 0.711 0.524~0.828 73.38 72.64
f 25% 0.709 0.528~0.787 71.53 69.66
Kep 1.35/min 0.727 0.576~0.849 73.98 75.23
Ktrans 0.41/min 0.732 0.653~0.812 74.69 74.81
Ve 0.36 0.721 0.523~0.806 75.97 72.65
联合 ≥2项异常 0.936 0.785~0.982 91.89 89.69
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