探讨磁共振动态增强扫描（DCE-MRI）联合CT能谱成像对肝细胞癌微血管侵犯（MVI）的预测价值。

回顾性分析2022年1月至2024年12月扬州大学附属医院收治的肝细胞癌患者90例的临床资料，所有患者均行DCE-MRI联合能谱CT扫描检查，根据病理检查MVI情况将患者分为两组，MVI组（n=41）和无MVI组（n=49），收集两组资料，构建受试者工作特征（ROC）曲线，计算曲线下面积（AUC）评估DCE-MRI和能谱CT单独及联合应用对MVI的预测效能。

MVI组的表观弥散系数（ADC）、血管外细胞外间隙体积百分比（V_e）低于无MVI组，速率常数（K_ep）、容积转移常数（K^trans）、标准化碘浓度（NIC）、动脉期能谱曲线斜率（λHU）、门静脉期λHU高于无MVI组，差异均有统计学意义（P<0.05）。多因素Logistic分析显示，ADC（OR=0.099，95% CI 0.028~0.348）、V_e（OR=0.145，95% CI 0.045~0.469）是肝细胞癌MVI的独立保护因素；而K_ep（OR=6.524，95% CI 2.341~18.181）、K^trans（OR=8.197，95% CI 2.594~25.900）、动脉期NIC（OR=24.915，95% CI 5.386~115.274）、动脉期λHU（OR=4.678，95% CI 1.915~11.429）及门静脉期λHU（OR=2.440，95% CI 1.157~5.145）是肝细胞癌MVI的独立危险因素（P<0.05）。其中动脉期NIC的OR值最高，提示其对MVI的预测价值最大。ROC曲线分析显示，各单一参数中对MVI预测效能最高的为动脉期NIC（AUC=0.873，95% CI 0.809~0.937），其次为K^trans（AUC=0.834，95% CI 0.761~0.907）和ADC值（AUC=0.812，95% CI 0.732~0.892）。将上述有统计学意义的独立预测因素构建联合预测模型后，其预测效能显著提高（AUC=0.902，95% CI 0.886~0.978），灵敏度为90.24%，特异性为87.76%。

DCE-MRI联合能谱CT有助于术前预测肝细胞癌MVI情况，其诊断效能优于任何单一模态，可为临床手术策略的选择及预后评估提供关键信息支持。

To explore the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with spectral CT for microvascular invasion (MVI) of hepatocellular carcinoma.

A retrospective analysis was conducted on the clinical data of 90 patients with hepatocellular carcinoma admitted to Affiliated Hospital of Yangzhou University from January 2022 to December 2024. All patients underwent DCE-MRI combined with spectral CT scan examination. According to the MVI situation in pathological examination, the patients were divided into two groups: the MVI group (n=41) and the non-MVI group (n=49). Two groups of data were collected, the receiver operating characteristic (ROC) curve was constructed, and the AUC was calculated to evaluate the predictive efficacy of DCE-MRI and spectral CT alone and in combination for MVI.

The apparent diffusion coefficient (ADC) and the percentage of extracellular space outside blood vessel (V_e) in the MVI group were lower than those in the non-MVI group, while the rate constant (K_ep), the volume transfer constant (K^trans), the standardized iodine concentration (NIC) in the arterial phase, the slope of the energy spectrum curve (λHU) in the arterial phase, and λHU in the portal vein phase were higher than those in the non-MVI group, with statistically significant differences (P<0.05). Multivariate Logistic analysis showed that ADC (OR=0.099, 95% CI: 0.028-0.348) and V_e (OR=0.145, 95% CI: 0.045-0.469) were independent protective factors for MVI in hepatocellular carcinoma. While K_ep (OR=6.524, 95% CI: 2.341-18.181), K^trans (OR=8.197, 95% CI: 2.594-25.900), and arterial phase NIC (OR=24.915, 95% CI: (5.386-115.274), λHU in the arterial phase (OR=4.678, 95% CI: 1.915-11.429), and λHU in the portal vein phase (OR=2.440, 95% CI: 1.157-5.145) were independent risk factors for MVI in hepatocellular carcinoma (P<0.05). Among them, the OR value of NIC in the arterial phase was the highest, suggesting that it had the greatest predictive value for MVI. ROC curve analysis showed that among each single parameter, the one with the highest predictive efficacy for MVI was arterial phase NIC (AUC=0.873, 95% CI: 0.809-0.937), followed by K^trans (AUC=0.834, 95% CI: (0.761-0.907) and ADC value (AUC=0.812, 95% CI: 0.732-0.892). After constructing a joint prediction model with the above-mentioned independent predictive factors of statistical significance, its predictive efficacy was significantly improved (AUC=0.902, 95% CI: 0.886-0.978), with a sensitivity of 90.24% and a specificity of 87.76%.

DCE-MRI combined with spectral CT is helpful for preoperative prediction of MVI in hepatocellular carcinoma, its diagnostic efficacy is superior to any single mode, providing key information support for the selection of clinical surgical strategies and prognosis evaluation.