磁共振增强扫描弥散加权成像对肝脏良恶性肿瘤的鉴别诊断价值研究

doi:10.3969/j.issn.1672-5069.2021.02.030

摘要/Abstract

摘要： 目的探讨磁共振增强扫描联合扩散加权成像(DWI)对肝脏良恶性病变鉴别诊断的临床价值。方法在80例肝脏局灶性病变患者接受3.0T磁共振成像(MRI)增强和DWI序列扫描,并接受手术治疗。以组织病理学检查结果为“金标准”,评估MRI和DWI的诊断效能。结果在本组80例肝脏局灶性病变患者中,术后组织病理学诊断肝细胞癌28例,肝转移癌24例,肝血管瘤19例,肝囊性病变9例;在b=50 s/ mm³时,肝细胞癌和肝转移癌患者肿瘤感兴趣区的表观弥散系数(ADC)分别为(2.42±0.21)和(2.45±0.35),均显著低于肝血管瘤和肝囊肿【分别为(2.65±0.37)和(2.71±0.37),P<0.05】,在b=400 s/ mm³时,肝细胞癌和肝转移癌患者肿瘤感兴趣区的ADC分别为(2.03±0.22)和(2.17±0.23),均显著低于肝血管瘤和肝囊肿【分别为(2.48±0.34)和(2.49±0.24),P<0.05】,在b=800 s/ mm³时,肝细胞癌和肝转移癌患者肿瘤感兴趣区的ADC分别为(1.75±0.26)和(1.82±0.18),也均显著低于肝血管瘤和肝囊肿【分别为(2.27±0.27)和(2.30±0.16),P<0.05】;MR增强扫描联合DWI对肝细胞癌、肝转移癌、肝血管瘤和肝囊肿的诊断率分别为96.4%、100.0%、100.0%和100.0%,显著高于增强扫描诊断[(分别为71.4%、75.0%、68.4%和66.7%),P<0.05]或DWI诊断[(分别为53.6%、45.8%、57.9%和55.6%),P<0.05]。结论磁共振增强扫描联合DWI 序列可有效提高对肝脏良恶性病变的诊断率,可帮助临床医师早期作出正确的诊断和合理的处置,对改善患者预后有极大的裨益。

关键词: 肝脏局灶性病变, 磁共振成像, 弥散加权成像, 诊断

Abstract: Objective The aim of this study was to evaluate the clinical value of diffusion-weighted magnetic resonance imaging (DWI) in diagnosing patients with focal lesions of liver (FLL).Methods A total of 80 patients with FLL were collected and they received MRI and DWI, and all received hepatectomy. The MRI diagnosis was estimated by histopathological examination.Results Out of the 80 patients with FLL, the histopathological examination showed that hepatocellular carcinoma (HCC) in 28 patients, liver metastasis in 24, hepatic hemangioma in 19 and hepatic cyst in 9; When b=50 s/ mm³, the apparent diffusion coefficient (ADC) of region of interest (ROI) in HCC and in liver metastasis were(2.42±0.21) and (2.45±0.35), both significantly lower than 【(2.65±0.37) and (2.71±0.37), respectively, P<0.05】 in patients with hepatic hemangioma and hepatic cyst, when b=400 s/ mm³, the ADC in patients with HCC and liver metastasis were (2.03±0.22) and (2.17±0.23), both significantly lower than 【(2.48±0.34) and (2.49±0.24), respectively, P<0.05】 in patients with hepatic hemangioma and hepatic cyst, and when b=800 s/ mm³, the ADC in patients with HCC and liver metastasis were(1.75±0.26) and (1.82±0.18), also both significantly lower than 【(2.27±0.27) and (2.30±0.16), respectively, P<0.05】 in patients with hepatic hemangioma and hepatic cyst; the diagnostic accuracy of HCC, liver metastasis, hepatic hemangioma and hepatic cyst by MRI and DWI combination were 96.4%, 100.0%, 100.0% and 100.0%, significantly higher than [(71.4%, 75.0%, 68.4% and 66.7%), respectively P<0.05] by intensified MRI or [(53.6%, 45.8%, 57.9% and 55.6%), respectively, P<0.05] by DWI alone.Conclusion The diffusion-weighted magnetic resonance imaging in differentiating benign and malignant focal lesions of liver is promising and practical in clinical practice, which might help the clinicians dealing with the patients with FLL appropriately and improve the prognosis.

Key words: Focal lesion of liver, Magnetic resonance imaging, Diffusion weighted imaging, Diagnosis

代小兵, 刘启榆, 吴俊辉. 磁共振增强扫描弥散加权成像对肝脏良恶性肿瘤的鉴别诊断价值研究[J]. 实用肝脏病杂志, 2021, 24(2): 268-271.

Dai Xiaobing, Liu Qiyu, Wu Junhui. Diagnosis of focal lesions of liver by diffusion-weighted magnetic resonance imaging[J]. Journal of Practical Hepatology, 2021, 24(2): 268-271.

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