MRI在脂肪肝背景下对局灶性结节性病变定性诊断价值分析*

doi:10.3969/j.issn.1672-5069.2025.01.036

摘要/Abstract

摘要： 目的分析不同模式磁共振成像(MRI)诊断脂肪肝背景下局灶性结节性病变(FNLL)性质的价值。方法 2019年12月～2022年12月我院诊治的脂肪肝合并FNLL患者113例,所有患者均接受磁共振弥散加权成像(MRI-DWI)和动态增强磁共振成像(DCE-MRI)检查,应用自动分析软件绘制时间-信号强度曲线,并对曲线进行分型。再接受细针活检穿刺病理学检查。应用Kappa检验,分析诊断的一致性。结果在113例脂肪肝合并FNLL患者中,病理学检查诊断为局灶性结节性增生(FNH)69例和肝细胞癌(HCC)44例; 恶性结节Ⅰ型、Ⅱ型和Ⅲ型时间-信号强度曲线占比分别为38.6%、52.3%和9.1%,而良性结节分别为2.9%、20.3%和76.8%,差异显著(P＜0.05);MRI-DWI联合DCE-MRI诊断恶性结节的灵敏度为93.2%,特异度为100.0%,准确性为97.3%,显著优于指标单独诊断(DCE-MRI分别为90.9%、88.4%和89.4%,MRI-DWI分别为90.9%、91.3%和91.2%,P＜0.05)。结论应用DCE-MRI和MRI-DWI联合诊断脂肪肝背景下FNLL的性质有较高的准确性,对于临床作出正确的诊断和治疗决策有很大的帮助。

关键词: 肝细胞癌, 局灶性结节性病变, 脂肪肝, 动态增强磁共振成像, 弥散加权成像, 诊断

Abstract: Objective This study was conducted to explore the qualitative diagnostic efficacy of focal nodular lesions of liver (FNLL) by magnetic resonance imaging (MRI) in patients with nonalcoholic fatty liver diseases(NAFLD). Methods A total of 113 patients with FNLL under the background of NAFLD were enrolled in our hospital between December 2019 and December 2022, and all patients were examined by diffusion-weighted magnetic resonance imaging (MRI-DWI) and dynamic enhanced magnetic resonance imaging (DCE-MRI), with the time-signal curve types recorded. The fine needle aspiration biopsy was performed for pathological diagnosis as the gold standard. The consistency of diagnoses by MRI-DWI and DCE-MRI with the gold standard was compared by Kappa test. Results Out the 113 patients with FNLL and NAFLD, the pathological examination showed focal nodular hyperplasia (FNH) in 69 cases and hepatocellular carcinoma (HCC) in 44 cases; the percentages of typeⅠ, type Ⅱ and type Ⅲ of time-signal curve in malignant lesions were 38.6%, 52.3% and 9.1%, significantly different compared to 2.9%, 20.3% and 76.8% in benign lesions (P＜0.05); the sensitivity, specificity and accuracy were 93.2%,100.0% and 97.3% when the qualitative diagnosis was made by the combination of MRI-DWI and DCE-MRI, much superior to 90.9%, 88.4% and 89.4% by DCE-MRI alone or 90.9%,91.3% and 91.2% by MRI-DWI alone (P＜0.05). Conclusion Theapplication of MRI, especially with DCE-MRI and MRI-DWI models, in the qualitative diagnosis of FNLL under the background of NAFLD is efficacious, which might help the clinicians make a correct diagnosis and deal with appropriately.

Key words: Hepatoma, Focal nodular lesion of liver, Nonalcoholic fatty liver diseases, Dynamic enhanced magnetic resonance imaging, Diffusion-weighted imaging, diagnosis

伏林, 张龄尹, 魏倩. MRI在脂肪肝背景下对局灶性结节性病变定性诊断价值分析^*[J]. 实用肝脏病杂志, 2025, 28(1): 140-143.

Fu Lin, Zhang Lingyin, Wei Qian. Application of MRI in qualitative diagnosis of focal nodular lesions of liver in patients with NAFLD[J]. Journal of Practical Hepatology, 2025, 28(1): 140-143.

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MRI在脂肪肝背景下对局灶性结节性病变定性诊断价值分析^*

Application of MRI in qualitative diagnosis of focal nodular lesions of liver in patients with NAFLD

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