磁共振成像增强扫描联合弥散加权成像评估良恶性肝脏肿瘤价值分析*

doi:10.3969/j.issn.1672-5069.2025.03.030

摘要/Abstract

摘要： 目的评估磁共振成像增强扫描(DCE-MRI)和弥散加权成像(DWI)鉴别诊断肝脏肿瘤良恶性的价值。方法 2022年1月～2023年12月我院诊治的肝脏肿瘤患者96例,行MRI检查,记录病灶速率常数(K_ep)、容量转移常数(K^trans)、血管外细胞外间隙容积比(V_e)、增强曲线下初始面积(iAUC)和弥散加权成像(ADC)。应用受试者工作特征曲线(ROC)评估诊断效能。结果经术后组织病理学检查,本组诊断肝腺瘤27例、肝硬化增生结节13例和局灶性结节性增生15例(良性55例),肝细胞癌31例和肝内胆管细胞癌10例(恶性41例);恶性病灶形状不规则、边缘粗糙和内部强化不均匀占比分别为68.3%、65.9%和68.3%,均显著高于良性病灶的36.4%、34.6%和38.2%(所有P＜0.05);恶性病灶K_ep 、K^trans 、V_e 和iAUC分别为(0.8±0.3)min^-1、(0.4±0.1)min^-1、(0.4±0.2)和(1.0±0.3),显著大于良性组【分别为(0.4±0.1)min^-1、(0.2±0.1)min^-1、(0.3±0.1)和(0.7±0.2),P＜0.05】,而ADC值为(1.0±0.4),显著小于良性病灶【(1.7±0.6),P＜0.05】;ROC曲线分析表明,应用DCE-MR参数联合ADC诊断恶性病变的特异性达到94.5%,而灵敏度也达到70.2%,具有很大的诊断价值。结论应用DCE-MRI联合DWI检查可以帮助临床诊断肝脏占位性病变性质,值得深入研究。

关键词: 肝细胞癌, 肝脏局灶性结节性增生, 磁共振成像增强扫描, 弥散加权成像, 诊断

Abstract: Objective This study was conducted to evaluate diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)and diffusion-weighted imaging(DWI)in patients with intrahepatic space-occupying lesions (SOL). Methods 96 patients with SOL were encountered in our hospital between January 2022 and December 2023, and all patients underwent DCE-MRI scan to record constant (Kep), volume transfer constant (Ktrans), extracellular extravascular space volume ratio (Ve) and initial enhancement curve area (iAUC) as well as apparent diffusion coefficient (ADC). Diagnosis was based on post-operational histo-pathological examination as gold standard. Diagnostic efficacy was assessed by receiver operating characteristic curve (ROC). Results Post-operational histo-pathological examination proved benign lesions in 55 cases, including hepatic adenoma in 27 cases, cirrhotic nodules in 13 and focal nodular hyperplasia of the liver in 15 cases, and malignant lesions in 41 cases, including hepatocellular carcinoma in 31 cases and intrahepatic cholangiocarcinoma in 10 cases; percentages of tumors withirregular shapes, rough edgesand uneven internal enhancement in malignant tumors were 68.3%, 65.9% and 68.3%, all much higher than 36.4%, 34.6%and 38.2%(all P＜0.05) in benign lesions; K_ep, K^trans ,V_e and iAUC in malignant lesions were (0.8±0.3)min^-1, (0.4±0.1)min^-1, (0.4±0.2) and (1.0±0.3), all significantly greater than [(0.4±0.1)min^-1, (0.2±0.1)min^-1, (0.3±0.1) and (0.7±0.2), respectively, P＜0.05], while ADC was (1.0±0.4), significantly smaller than [(1.7±0.6),P＜0.05] in benign lesions; ROC analysis showed that the specificity reached to 94.5%, with sensitivity of 70.2%, when parameters of DCE-MRI and ADC combination in determining malignant lesions. Conclusion DCE-MRI is helpful in judging the quality of intrahepatic SOL, which warrants further clinical investigation.

Key words: Hepatoma, Dynamic contrast-enhanced magnetic resonance imaging, Diffusion-weighted imaging, Diagnosis

沙新杰, 夏晓亮. 磁共振成像增强扫描联合弥散加权成像评估良恶性肝脏肿瘤价值分析^*[J]. 实用肝脏病杂志, 2025, 28(3): 438-441.

Sha Xinjie, Xia Xiaoliang. Diagnosis of benign and malignant liver tumors by magnetic resonance imaging enhancement scanning and diffusion-weighted imaging[J]. Journal of Practical Hepatology, 2025, 28(3): 438-441.

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磁共振成像增强扫描联合弥散加权成像评估良恶性肝脏肿瘤价值分析^*

Diagnosis of benign and malignant liver tumors by magnetic resonance imaging enhancement scanning and diffusion-weighted imaging

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