增强MRI联合IVIM-DWI诊断小肝细胞癌价值研究*

doi:10.3969/j.issn.1672-5069.2024.04.024

摘要/Abstract

摘要： 目的探讨增强磁共振(MRI)联合体素内不相干运动磁共振扩散加权成像(IVIM-DWI)诊断小肝细胞癌(sHCC)的价值。方法 2020年5月～2023年5月我院收治的肝脏局灶性病变患者73例,所有患者均接受增强MRI和IVIM-DWI检查,观察病灶增强强化信号特点,分析病灶IVIM-DWI定量参数,即伪扩散系数(D^*)、真实扩散系数(D)和灌注分数(f)。采用细针穿刺或取术后组织行病理学检查。应用受试者特征工作曲线(ROC)下面积(AUC)评估增强MRI联合IVIM-DWI诊断sHCC的效能。结果经病理学检查,在73例肝脏局灶性病变患者中,诊断sHCC者49例(67.1%)和肝脏异型性增生结节(DN)者24例(32.9%);sHCC病灶T1WI低信号、T2WI高信号、动脉期强化和肝胆期低信号占比分别为61.2%、83.7%、59.2%和89.8%,均显著高于DN病灶的20.8%、33.3%、25.0%和29.2%(P＜0.05);sHCC病灶D^*和D分别为(50.9±11.6)×10^-3mm²/s和(0.8±0.2)×10^-3mm²/s,均显著小于DN病灶【分别为(78.4±15.8)×10^-3mm²/s和(1.2±0.3)×10^-3mm²/s,P＜0.05】,而两组f比较,差异无统计学意义【分别为(45.6±8.7)%对(43.9±9.5)%,P＞0.5】;ROC分析表明,应用T1WI信号、T2WI信号、动脉期强化、肝胆期信号、D^*和D联合诊断sHCC的AUC为0.968,其灵敏度和特异度分别为100.0%和86.0%。结论应用增强MRI和IVIM-DWI联合诊断sHCC的效能较高,可为临床诊疗提供有益的依据,值得进一步深入研究。

关键词: 小肝细胞癌, 肝脏异型性增生结节, 磁共振成像, 体素内不相干运动磁共振扩散加权成像, 诊断

Abstract: Objective The aim of this study was to explore the diagnostic performance of contrast-enhanced magnetic resonance imaging (MRI) and intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI) in patients with small hepatocellular carcinoma (sHCC). Methods 73 patients with focal nodular hyperplasia (FNH ) were enrolled in our hospital between May 2020 and May 2023, and all patients underwent contrast-enhanced MRI and IVIM-DWI, recording the pseudo diffusion coefficient (D^*), true diffusion coefficient (D) and perfusion fraction (f). The fine needle aspiration biopsies or postoperative histopathology were performed for golden diagnosis. The diagnostic efficacy of contrast-enhanced MRI and IVIM-DWI was evaluated by receiver operating characteristic (ROC) curves. Results Among the 73 patients with FNH, the histopathology examination showed sHCC in 49 cases (67.1%) and the dysplastic nodules (DN) in 24 cases(32.9%); the percentages of low signals on T1WI, high signals on T2WI, arterial phase enhancement and low signals during hepatobiliary phase in HCC lesions were 61.2%, 83.7%, 59.2% and 89.8%, all significantly higher than 20.8%, 33.3%, 25.0% and 29.2%(P＜0.05) in DN lesions; the D^* and D in HCC lesions were (50.9±11.6)×10^-3mm²/s and (0.8±0.2)×10^-3mm²/s, both significantly less than [(78.4±15.8)×10^-3mm²/s and (1.2±0.3)×10^-3mm²/s, P＜0.05] in DN lesions, while there was no significant difference as respect to f between the two lesions [(45.6±8.7)% vs.(43.9±9.5)%, P＞0.5]; the ROC analysis showed the AUC was 0.968, with the sensitivity of 100.0% and the specificity of 86.0%, when the T1WI and T2WI signals, arterial phase enhancement, hepatobiliary phase signal, D^* and D was combined for the diagnosis of sHCC. Conclusion The contrast-enhanced MRI and IVIM-DWI are efficacious in the diagnosis of patients with sHCC, which might provide the clinicians a reliably tool for early differentiation of patients with FNH.

Key words: Hepatoma, Dysplastic nodules, Contrast-enhanced magnetic resonance imaging, Intravoxel incoherent motion-diffusion weighted imaging, Diagnosis

夏礼鹏, 褚玉玄, 赵如盛. 增强MRI联合IVIM-DWI诊断小肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2024, 27(4): 587-590.

Xia Lipeng, Chu Yuxuan, Zhao Rusheng. Contrast-enhanced MRI and IVIM-DWI in the diagnosis of patients with small hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2024, 27(4): 587-590.

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增强MRI联合IVIM-DWI诊断小肝细胞癌价值研究^*

Contrast-enhanced MRI and IVIM-DWI in the diagnosis of patients with small hepatocellular carcinoma

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