| OBJETIVE: To evaluate the clinical application of the hepatobiliary phase with liver specific contrast agent gadobenate dimeglumine?Gd-BOPTA?-enhanced MRI combined with diffusion weighted imaging in characterizing the grade of hepatocellular carcinoma?HCC?.MATERIALS AND METHODS: This retrospective study reviewed the clinical and Gd-BOPTA-enhanced MRI data of 86 patients?a total of 86 lesions?confirmed by pathology for HCC from December 2014 to February 2017.Patients were pathologically graded according to standard Edmondson-Steiner pathologic grading system and divided into well-differentiated HCC group,moderately-differentiated HCC group and poorly-differentiated HCC group.Measuring the signal intensity of lesions?SIles?,the signal intensity of the right erector spinae?SImus?and standard deviation of signal intensity of the surrounding noise?SDnoi?on hepatobiliary phase.The region of interest?ROI?was placed in the solid part of the lesion where the diameter of the lesion is largest,Contrast-to-noise ratio in the hepatobiliary phase was counted as CNRhbp??SIles-SIhep?/SDnoi?.The ADC value of the lesion was measured on ADC map comparing with the unenhanced T2 WI,the arterial phase of contrast-enhanced T1 WI and DWI,and the ROI was placed in the solid part of the lesion where the signal of the lesion on ADC map is lowest.Comparing the difference of the CNRhbp and the ADC value between the three different differentiation groups of HCC.Univariate analysis was performed when the datas obey the normal distribution and homogeneity of variance,and then using the LSD method for Post Hoc Multiple Comparisons if there were significant differences bofore.The nonparametric test?Kruskal-Wallis H test?was performed when the datas does not obey the normal distribution or homogeneity of variance,and then using the Mann-Whitney U test for Post Hoc Multiple Comparisons if there were significant differences bofore.Spearman rank correlation analysis was used to analyze the relationship between the pathological grade of HCC and CNRhbp and ADC values.Receiver operating characteristic?ROC?curves were performed to evaluate the significance in distinguishing well-differentiated HCC and moderately-differentiated HCC from poorly-differentiated HCC using CNRhbp and ADC values,respectively.Further more,The logistic regression analysis and ROC curve were performed to evaluate the significance in distinguishing well-differentiated HCC and moderately-differentiated HCC from poorly-differentiated HCC using CNRhbp combined with ADC values.RESULTS:?1?The CNRhbp median of the well-,moderately-and poorly-differentiated HCC were 32.72,14.20,-0.72,respectively.There were statistically significant differences?P=0.006?in the value of CNRhbp between different pathological differentiation groups.The value of CNRhbp in the poorly-differentiated HCC was significantly lower than that in the well-differentiated HCC?P=0.015?and moderately-differentiated HCC?P=0.007?,but there was no significant difference between the well-differentiated HCC and moderately-differentiated HCC?P=0.211?.The CNRhbp value of HCC was negatively correlated with pathological grade?r=-0.347,P=0.001?.?2?The ADC value of the well-,moderately-and poorly-differentiated HCC were?1.25±0.24?×10-3 mm2/s??0.89±0.18?×10-3 mm2/s??0.73±0.20?×10-3 mm2/s respectively,and there were statistically significant differences?P<0.001?in the ADC value between different pathological differentiation groups.The ADC values of poorly-differentiated HCC were statistically lower than those of well-differentiated HCC?P<0.001?and moderately-differentiated HCC?P<0.001?,and the ADC values of moderately-differentiated HCC lower than those of well-differentiated HCC was also statistically significant?P<0.001?.The ADC value of HCC was negatively correlated with pathological grade?r=-0.347,P<0.001?.?3?ROC curve analysis showed the sensitivity,specificity,when an CNRhbp and ADC of 0.195 and 0.762×10-3 mm2/s or lower was considered an indicator of poorly-differentiated HCC,were 80.70%?51.70% and 80.70%?58.60%,respectively.?4?ROC curve analysis showed that the area under the curve of the CNRhbp value,ADC value,CNRhbp value combined with ADC value was 0.696?95%CI,0.588-0.791?,0.729?95%CI,0.623-0.820?,0.745?95%CI,0.640-0.833?,respectively.There were no significant difference between the groups?P>0.05?.CONCLUSION:?1?There was significant difference in CNRhbp value between different pathological differentiation groups of HCC,and the CNRhbp value of HCC was negatively correlated with pathological grade.?2?There was significant difference in ADC value between different pathological differentiation groups of HCC,and the ADC value of HCC was negatively correlated with pathological grade.?3?Both CNRhbp value and ADC value had a clear predictive value for the pathological grade of HCC,but CNRhbp value combined with ADC value did not improve the predictive value of HCC pathological grade.?4?CNRhbp =0.195 or ADC =0.762 * 10-3 mm2/s has a certain clinical value in differential diagnosis of well differentiated HCC and poorly differentiated HCC. |
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