Application of TTPVI based on CT and MRI imaging to display microvascular invasion in patients with liver cancer

doi:10.3760/cma.j.issn.1007-1245.2024.13.024

Abstract

Abstract:

Objective　To explore the value of two-trait predictor of venous invasion (TTPVI) of CT and MRI in the diagnosis of microvascular invasion in patients with primary liver cancer. Methods　One hundred and twelve patients with primary liver cancer admitted to Xi'an Eighth Hospital between June 2022 and September 2023 were selected as the study objects. They were divided into an invasive group and a non-invasive group based on microvascular invasion. The marginal fuzzy signs, TTPVI, and portal vein tumor thrombus (PVTT) of CT or MRI before the operation were compared between the two groups. The diagnostic efficacies of the above indicators for microvascular invasion in the patients with primary liver cancer were analyzed by the receiver operating characteristic curves (ROC). t test, χ² test, and rank sum test were used. Results　Among the 112 patients, 25 cases (22.32%) experienced microvascular invasion. The proportions of borderline fuzzy signs, TTPVI, and PVTT in the invasive group were 60.00% (15/25), 72.00% (18/25), and 16.00% (4/25), respectively, which were significantly higher than those in the non-invasive group (χ²=38.968, 40.349, and 14.436, all P<0.05). The incidence rates of edge blurry signs such as multiple sign overlap, multiple nodule fusion, incomplete local capsule, and local protruding nodules in the invasive group were 12.00% (3/25), 16.00% (4/25), 12.00% (3/25), and 12.00% (3/25), respectively, which were significantly higher than those in the non-invasive group (χ²=6.639, 10.042, 6.639, and 4.285; all P<0.05). The areas under the ROC's (AUC) of edge blurred signs, TTPVI, and PVTT of CT and MRI for microvascular invasion in the patients were 0.771 (95%CI 0.648-0.894), 0.828 (95%CI 0.723-0.934), and 0.580 (95%CI 0.443-0.717), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative TTPVI in diagnosing microvascular invasion in the patients were 72.00%, 89.66%, 66.67%, and 91.76%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative blurred signs in diagnosing microvascular invasion in the patients were 60.00%, 94.25%, 75.00%, and 89.13%, respectively. The AUC of TTPVI combined with edge blurred signs for microvascular invasion in the patients was 0.821 (95%CI 0.703～0.938); the sensitivity, specificity, positive predictive value, and negative predictive value were 76.00%, 89.66%, 67.86%, and 92.86%, respectively. Conclusion　Preoperative blurred edges and TTPVI of CT and MRI have certain diagnostic value for microvascular invasion in patients with primary liver cancer, and their combined efficacy is better.

Key words:

Primary liver cancer, Microvascular invasion, CT, MRI, Two-trait predictor of venous invasion

摘要：

目的　探讨基于CT和MRI检查参数瘤内动脉和低密度/信号环征象（two-trait predictor of venous invasion，TTPVI）在原发性肝癌患者微血管侵犯诊断中的价值。方法　选择2022年6月至2023年9月西安市第八医院收治的112例原发性肝癌患者作为研究对象，根据微血管侵犯情况分为侵犯组和无侵犯组。比较两组患者术前CT或MRI边缘模糊征象、TTPVI、门脉分支癌栓（portal vein tumor thrombus，PVTT）。采用受试者操作特征曲线（receiver operating characteristic curve，ROC）分析上述指标对原发性肝癌患者微血管侵犯的诊断效能。采用t检验、χ²检验和秩和检验。结果　112例原发性肝癌患者中，25例（22.32%）发生微血管侵犯。侵犯组边缘模糊征象、TTPVI、PVTT比例分别为60.00%（15/25）、72.00%（18/25）、16.00%（4/25），均高于非侵犯组（χ²=38.968、40.349、14.436，均P <0.05）。侵犯组多征象叠加、多结节融合、局部包膜不完整、局部外凸结节等边缘模糊征象类型发生比例分别为12.00%（3/25）、16.00%（4/25）、12.00%（3/25）、12.00%（3/25），均高于非侵犯组（χ²=6.639、10.042、6.639、4.285，均P <0.05）。CT和MRI边缘模糊征象、TTPVI和PVTT诊断原发性肝癌患者发生微血管侵犯ROC下面积（AUC）分别为0.771（95%CI 0.648～0.894）、0.828（95%CI 0.723～0.934）和0.580（95%CI 0.443～0.717）。术前TTPVI诊断原发性肝癌患者微血管侵犯的灵敏度、特异度、阳性预测值和阴性预测值分别为72.00%、89.66%、66.67%和91.76%，术前CT和MRI边缘模糊征象诊断原发性肝癌患者微血管侵犯的灵敏度、特异度、阳性预测值和阴性预测值分别为60.00%、94.25%、75.00%和89.13%。CT和MRI边缘模糊征象联合TTPVI诊断原发性肝癌患者发生微血管侵犯的AUC为0.821（95%CI 0.703～0.938），灵敏度、特异度、阳性预测值和阴性预测值分别为76.00%、89.66%、67.86%和92.86%。结论　术前CT和MRI边缘模糊征象、TTPVI对原发性肝癌患者微血管侵犯具有一定的诊断价值，二者联合效能更好。

关键词:

原发性肝癌, 微血管侵犯, CT, MRI, 瘤内动脉和低密度/信号环征象

Shi Sanli, Zhang Jianping, Li Fen, Yang Lijuan, Guo Wanliang.

Application of TTPVI based on CT and MRI imaging to display microvascular invasion in patients with liver cancer [J]. International Medicine and Health Guidance News, 2024, 30(13): 2240-2244.

石三利张建平李芬杨丽娟郭万亮.

基于CT和MRI的TTPVI在肝癌患者微血管侵犯诊断中的价值 [J]. 国际医药卫生导报, 2024, 30(13): 2240-2244.

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