关键词: 肝细胞癌, 多模态超声, 微血管浸润, 术前预测模型, 预测效能

Abstract:

Objective　To construct a preoperative prediction model of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) by multimodal ultrasound. Methods　A total of 121 patients with HCC treated at Shaanxi Nuclear Industry 215 Hospital from June 2022 to September 2024 were selected as the study objects, and were divided into an MVI occurrence group and a non-occurrence group according to the preoperative pathological examination results. All the patients completed multimodal ultrasound examinations, such as two-dimensional ultrasound and contrast-enhanced ultrasound, and the relevant parameters were recorded. Both groups' medical records were reviewed to analyze the possible influencing factors of MVI in HCC. The nomogram was drawn, and a preoperative prediction model of MVI in the patients was constructed; the predictive efficacy was analyzed and verified. t and χ² tests were used for the statistical analysis. Results　Among the 121 patients, 35 (28.93%) had MVI. The univariate and multivariate analyses results showed that lesion size and signals during the arterial phase (AP), portal phase (PP), and posterior vascular phase (PVP) were the independent risk factors for MVI in the patients (all P<0.05). The established model formula was as below: Logit (P)=12.151+4.280×lesion size-AP×10.089-PP×6.231-PVP×4.710, which was used to predict the occurrence of MVI in the patients before surgery. The receiver operating characteristic curve results showed that the area under the curve (AUC) of the occurrence group was 0.971 (95%CI 0.934-1.000), and that of the non-occurrence group 0.886 (95%CI 0.751-1.000). The results of decision curve showed that when the threshold probability of the occurrence group was 0-0.4 and the threshold probability of the non-occurrence group was 0.1-1.0, the model had a higher positive net profit. The clinical impact curve results showed that the prediction accuracy of the model was high when the threshold probability of the occurrence group was 0-0.4 and the threshold probability of the non-occurrence group was 0-0.7. Conclusions　The occurrence of MVI in patients with HCC is often affected by lesion size and signals during AP, PP, and PVP. The prediction model of MVI in patients with HCC based on multimodal ultrasound parameters has high predictive efficacy.

Key words: Hepatocellular carcinoma,  , Multimodal ultrasound,  , Microvascular invasion,  , Preoperative prediction model,  , Predictive efficacy