高场磁共振多b值弥散加权成像鉴别诊断肝血管瘤与肝细胞癌价值探讨*

doi:10.3969/j.issn.1672-5069.2023.01.027

摘要/Abstract

摘要： 目的探讨高场磁共振多b值弥散加权成像(DWI)鉴别诊断肝血管瘤(HH)与肝细胞癌(HCC)的价值。方法 2019年6月～2021年5月我院收治的85例肝脏局灶性占位性病变(FLL)患者,均接受高场MRI检查,记录不同b值下表观扩散系数(ADC)。均接受肝叶切除术,行组织病理学检查。绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估ADC的鉴别诊断价值。结果在85例FLL患者中,术后组织病理学检查诊断为HH者28例(32.9%)、肝局灶性结节性增生( FNH)者18例(21.2%)和肝细胞癌(HCC)者39例(45.9%);在b值=50 s/mm²、b值=400 s/mm²和b值=1000 s/mm²时,HCC病灶ADC值分别为(2.41±0.20)×10^-3/mm²/s、(2.02±0.19)×10^-3/mm²/s和(1.73±0.15)×10^-3/mm²/s,FNH病灶分别为(2.43±0.31)×10^-3/mm²/s、(2.05±0.21)×10^-3/mm²/s和(2.01±0.18)×10^-3/mm²/s,均显著低于HH病灶【分别为(2.63±0.35)×10^-3/mm²/s、(2.46±0.32)×10^-3/mm²/s和(2.25±0.23)×10^-3/mm²/s,P＜0.05】;根据b值=1000 s/mm²时HH与HCC病灶ADC值绘制ROC曲线,结果显示,以高场磁共振ADC=1.73×10^-3/mm²/s为最佳截断点,其鉴别HH与HCC的AUC(95%CI)为0.727(0.581～0.844,P＜0.05),约登指数为0.559,其灵敏度为80.0%,特异度为75.9%。结论采用高场磁共振DWI鉴别诊断HH与HCC病灶具有很大的临床价值,我们推荐应用b值为1000s/mm²时高场磁共振DWI可能鉴别诊断价值更高。

关键词: 肝细胞癌, 肝血管瘤, 高场磁共振, 弥散加权成像, 表观扩散系数, 鉴别价值

Abstract: Objective The aim of this study was to investigate the differential diagnosis of hepatic hemangioma (HH) and hepatocellular carcinoma (HCC) by multi-b-value diffusion-weighted imaging (DWI) of high-field magnetic resonance (MR). Methods 85 patients with focal space-occupying liver lesions (FLL) were encountered in our hospital between June 2019 and May 2021, and all underwent high-field magnetic resonance and the apparent diffusion coefficient (ADC) was recorded. All patients received hepatectomy, and the histopathological examination was performed. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to testify the differential diagnosis performance of ADC value for HH and HCC. Results The results of pathological examination post-operationally showed that among the 85 patients with FLL, the HH was found in 28 cases (32.9%), the focal liver nodular hyperplasia (FNH) was found in 18 cases (21.2%) and the HCC was found in 39 cases (45.9%); the ADC of cancerous foci at b=50 s/mm², b=400 s/mm² and b=1000 s/mm² were (2.41±0.20)×10^-3/mm²/s, (2.02±0.19)×10^-3/mm²/s and (1.73±0.15)×10^-3/mm²/s, the ADC of FNH foci were (2.43±0.31)×10^-3/mm²/s, (2.05±0.21)×10^-3/mm²/s and (2.01±0.18)×10^-3/mm²/s, all significantly lower than [(2.63±0.35)×10^-3/mm²/s, (2.46±0.32)×10^-3/mm²/s and (2.25±0.23)×10^-3/mm²/s, respectively, P＜0.05] in HH foci; the ROC was drawn based on ADC at b=1000 s/mm², and the ADC=1.73×10^-3/mm²/s was set as the optimal cut-off-value for differential diagnostic of HH and HCC, the performance is excellent with the AUC(95%CI) of 0.727(0.581-0.844, P＜0.05), the sensitivity of 80.0% and the specificity of 75.9%. Conclusion The high-field magnetic resonance imaging has a great importance in the differential diagnosis of hepatic hemangioma and hepatocellular carcinoma, and we recommend the ADCs at b equal to 1000s/mm², which needs further clinical investigation.

Key words: Hepatoma, Hepatic hemangioma, High-field magnetic resonance, Diffusion-weighted imaging, Apparent diffusion coefficient, Differential diagnosis

高祥瑞, 刘红岩, 张淮, 葛尚. 高场磁共振多b值弥散加权成像鉴别诊断肝血管瘤与肝细胞癌价值探讨^*[J]. 实用肝脏病杂志, 2023, 26(1): 104-107.

Gao Xiangrui, Liu Hongyan, Zhang Huai, et al. Differential diagnosis of hepatic hemangioma and hepatocellular carcinoma by multi-b-value diffusion-weighted imaging of high-field magnetic resonance[J]. Journal of Practical Hepatology, 2023, 26(1): 104-107.

参考文献

[1] Luo Y, Yue W, Li Z, et al. Contrast-enhanced ultrasound and its differential diagnosis in 21 patients with intrahepatic space-occupying lesions under the background of fatty liver. Ann Palliat Med,2021,10(3):3097-3104.
[2] Thyagarajan M S, Sharif K. Space occupying lesions in the liver. Indian J Pediatr,2016,83(11):1291-1302.
[3] Zou X, Luo Y, Morelli J N, et al. Differentiation of hepatocellular carcinoma from intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma in high-risk patients matched to MR field strength: diagnostic performance of LI-RADS version 2018. Abdom Radiol (NY),2021,46(7):3168-3178.
[4] Greenwood H I, Freimanis R I, Carpentier B M, et al. Clinical breast magnetic resonance imaging: technique, indications, and future applications. Semin Ultrasound CT MR,2018,39(1):45-59.
[5] 黄成. 2016年欧洲肝病学会临床实践指南:肝脏良性肿瘤的管理. 临床肝胆病杂志,2016,32(8):1439-1445.
[6] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版). 中华消化外科杂志,2020,19(1):1-20.
[7] Inglese M, Fleysher L, Oesingmann N, et al. Clinical applications of ultra-high field magnetic resonance imaging in multiple sclerosis. Expert Rev Neurother,2018,18(3):221-230.
[8] 程华才,陈家祥,马岩,等. 弥散加权成像在肝脏局灶性病变中的应用. 中国CT和MRI杂志,2011,9(2):49-51.
[9] Hori M, Kamiya K, Murata K. Technical basics of diffusion-weighted imaging. Magn Reson Imaging Clin N Am,2021,29(2):129-136.
[10] Surov A, Pech M, Omari J, et al. Diffusion-weighted imaging reflects tumor grading and microvascular invasion in hepatocellular carcinoma. Liver Cancer,2021,10(1):10-24.
[11] Li Z, Mao Y, Huang W, et al. Texture-based classification of different single liver lesion based on SPAIR T2W MRI images. BMC Med Imaging,2017,17(1):42.
[12] 汪建华,王玉涛,马小龙,等. 磁共振成像在自身免疫性胰腺炎诊断与鉴别诊断中的价值. 中华消化杂志,2014,34(4):260-265.
[13] Lahrsow M, Albrecht M H, Bickford M W, et al. Predicting treatment response of colorectal cancer liver metastases to conventional lipiodol-based transarterial chemoembolization using diffusion-weighted MR imaging: value of pretreatment apparent diffusion coefficients (ADC) and ADC changes under therapy. Cardiovasc Intervent Radiol,2017,40(6):852-859.
[14] Xu Q, Huang Y, Shi H, et al. Sunitinib versus sorafenib plus transarterial chemoembolization for inoperable hepatocellular carcinoma patients. J Buon,2018,23(1):193-199.
[15] Tokgoz O, Unlu E, Unal I, et al. Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver. Afr Health Sci,2016,16(1):227-233.
[16] Harada T L, Saito K, Araki Y, et al. Prediction of high-stage liver fibrosis using ADC value on diffusion-weighted imaging and quantitative enhancement ratio at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI at 1.5 T. Acta Radiol,2018,59(5):509-516.
[17] Poon R T, Ngan H, Lo C M, et al. Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol,2016,73(2):109-114.
[18] Ranjpour M, Wajid S, Jain SK.. Elevated expression of cytosolic phospholipase A2 delta is associated with lipid metabolism dysregulation during hepatocellular carcinoma progression.Cell J, 2020,22(1):17-22.
[19] Kumar P, Agarwal A, Singh AK, et al. Antineoplastic properties of zafirlukast against hepatocellular carcinoma via activation of mitochondrial mediated apoptosis. Regul Toxicol Pharmacol, 2019,109:104489.
[20] Park M J, Kim Y K, Lee M W, et al. Small hepatocellular carcinomas: improved sensitivity by combining gadoxetic acid-enhanced and diffusion-weighted MR imaging patterns. Radiology,2012,264(3):761-770.
[21] Erturk S M, Ichikawa T, Kaya E, et al. Diffusion tensor imaging of cysts, hemangiomas, and metastases of the liver. Acta Radiol,2014,55(6):654-660.
[22] Xiaotong S, Jutong S, Hua H, et al. Hsa_circ_0070269 inhibits hepatocellular carcinoma progression through modulating miR-182/NPTX1 axis. Biomed Pharmacother. 2019,120:109497.
[23] 钟锐,张敏,何浩强,等. B值800s/mm2磁共振弥散加权成像(DWI)在肝脏占位性病变鉴别诊断中的应用. 中国CT和MRI杂志,2011,9(6):1-4.

高场磁共振多b值弥散加权成像鉴别诊断肝血管瘤与肝细胞癌价值探讨^*

Differential diagnosis of hepatic hemangioma and hepatocellular carcinoma by multi-b-value diffusion-weighted imaging of high-field magnetic resonance

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