增强MRI检查诊断HCC价值研究*

doi:10.3969/j.issn.1672-5069.2024.06.028

摘要/Abstract

摘要： 目的探讨增强MRI肝脏影像报告和数据系统(LI-RADS)诊断肝细胞癌(HCC)的效能。方法 2021年6月～2023年7月我院诊治的经手术后或穿刺组织病理学检查诊断的肝内占位性病变患者100例,均接受钆塞酸二钠(Gd-EOB-DTPA)MR扫描检查,应用LI-RADS v2018评估病灶分类,其中HCC主要征象包括非环状动脉期高强化(APHE)、廓清、包膜强化,考虑恶性可能的辅助征象包括非强化包膜、马赛克结构、结中结、病灶内含脂、出血、晕环状强化、病灶内乏脂、病灶内乏铁、DWI扩散受限和轻中度T2高信号等。结果组织病理学诊断为HCC者79例(92个病灶),肝脏异型增生性结节(DN)者14例(22个病灶)和肝硬化再生性结节(RN)者7例(11个病灶);HCC病灶非环状APHE、廓清迅速和包膜强化发生率分别为82.6%、80.4%和33.7%,显著高于DN病灶(分别为45.4%、45.4%和9.1%,P<0.05)或RN病灶(分别为36.4%、45.4%和0.0%,P<0.05);HCC病灶MRI辅助征象中DWI扩散受限、轻中度T2高信号、过渡期低信号和肝胆期低信号发生率分别为85.9%、88.0%、84.8%和91.3%,显著高于DN病灶(分别为59.1%、63.6%、45.4%和63.6%,P<0.05)或RN病灶(分别为45.4%、54.5%、45.4%和54.5%,P<0.05);基于MRI主要和辅助征象诊断LR-4/5 HCC病灶的敏感度为95.6%,显著高于基于主要征象诊断的79.3%(P<0.05),而两者诊断的特异度(51.5%对42.4%)和准确度(84.0%对72.0%)无显著性统计学差异(P>0.05)。结论基于MRI的LI-RADS分类系统可以帮助临床诊断HCC病灶,有利于与良性病灶鉴别,有很大的临床应用价值,值得深入研究。

关键词: 肝细胞癌, 增强MRI, 肝脏影像报告和数据系统, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of MRI scan based on liver imaging report and data system (LI-RADS) in diagnosis of patients with hepatocellular carcinoma (HCC). Methods 100 patients with intra-hepatic space-occupying lesions (IH-SOL) were encountered in our hospital between June 2021 and July 2023, all underwent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MR scan, and lesions were classified based on LI-RADS v2018. The main MRI features of HCC included non-circular arterial phase hyperintense (APHE), rapid clearance and enhanced capsule, and the possible auxiliary signs considered as malignant included non-enhanced capsules, mosaic structures, nodules, fat inside lesions, hemorrhage, halo enhancement, fat deficiency in lesions, iron deficiency, limited diffusion of DWI and mild and moderate T2 high signals. Results Liver histo-pathological examination showed HCC in 79 cases, including 92 lesions, dysplasia nodule (DN) in 14 cases, including 22 lesions and cirrhotic regenerative nodule (RN) in 7 cases, including 11 lesions; incidences of acyclic APHE, rapid clearance and enhanced capsule in HCC lesions were 82.6%, 80.4% and 33.7%, all much higher than 45.4%, 45.4% and 9.1% (P<0.05) in DN lesions or 36.4%, 45.4% and 0.0% (P<0.05) in RN lesions; as for auxiliary signs of HCCs lesions, the incidences of DWI diffusion limitation, mild to moderate T2 hyper-intensity, low signal at transitional phase and low signal at hepatobiliary phase were 85.9%, 88.0%, 84.8% and 91.3%, all much higher than 59.1%, 63.6%, 45.4% and 63.6% (P<0.05) in DN lesions or 45.4%, 54.5%, 45.4% and 54.5% (P<0.05) in RN lesions; the sensitivity by main and auxiliary signs in predicting HCC for LR-4/5 lesions was 95.6%, much higher than 79.3%(P<0.05) by main signs alone, while there were no significant differences as respect to specificity (51.5% vs. 42.4%) or accuracy(84.0% vs. 72.0%) by MRI main or main and auxiliary sign combination (P>0.05). Conclusion The diagnostic efficacy of MRI LI-RADS in differentiating malignant and benign IH-SOL is satisfactory, which might help clinicians make correct diagnosis early and make an appropriate measures for good outcomes.

Key words: Hepatocellular carcinoma, MRI, Liver imaging report and data system, Diagnosis

丹巴玉珍, 程盼. 增强MRI检查诊断HCC价值研究^*[J]. 实用肝脏病杂志, 2024, 27(6): 911-914.

Danba Yuzhen, Cheng Pan. Gd-EOB-DTPA-enhanced MRI scan in diagnosis of patients with hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2024, 27(6): 911-914.

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增强MRI检查诊断HCC价值研究^*

Gd-EOB-DTPA-enhanced MRI scan in diagnosis of patients with hepatocellular carcinoma

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