定量动态增强MRI诊断肝脏局灶性病变价值研究*

doi:10.3969/j.issn.1672-5069.2025.05.034

摘要/Abstract

摘要： 目的探讨定量动态增强磁共振成像(DCE-MRI)对肝脏局灶性病变(FLL)的诊断价值。方法 2022年2月～2024年7月连云港市第二人民医院诊治的103例FLL患者,均接受DCE-MRI检查,并经过手术或肝穿刺活检病理学检查诊断。采用Kappa检验分析DCE-MRI与金标准诊断的一致性,采用ROC曲线分析DCE-MRI的诊断效能。结果经病理学检查诊断肝细胞癌(HCC)64例,肝内胆管细胞癌(ICC)12例,肝局灶性结节性增生(FNH)8例和肝血管瘤(HH)19例;HCC和HH病灶DCE-MRI动脉期富血供占比分别为90.6%和100.0%,均显著高于ICC病灶的41.7%或FNH病灶的75.0%(P＜0.05);HH病灶DCE-MRI定量参数Ktrans、Kep和Ve分别为(0.4±0.1)、(0.5±0.1)和(0.7±0.2),而FNH病灶分别为(0.3±0.1)、(0.4±0.1)和(0.5±0.1),均显著低于HCC病灶【分别为(0.7±0.2)、(0.9±0.3)和(1.1±0.4),P＜0.05】或ICC病灶【分别为(0.6±0.2)、(0.8±0.3)和(1.0±0.3),P＜0.05】;DCE-MRI检查诊断HCC的灵敏度、特异度和准确率分别为93.8%、92.3%和93.2%,诊断ICC分别为83.3%、95.6%和94.2%,诊断FNH分别为75.0%、97.9%和96.1%,诊断HH分别为89.5%、98.8%和97.1%,与病理学检查诊断的一致性均较好(均kappa>0.7)。结论定量DCE-MRI检查对于FLL的定性诊断应用价值较高,可帮助临床医生作出合适的医疗干预选择。

关键词: 肝脏局灶性病变, 肝细胞癌, 动态增强磁共振成像, 定量参数, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)in patients with focal liver lesions (FLL). Methods 103 consecutive patients with FLL were encountered in Second People's Hospital, Lianyungang, Jiangsu Province between February 2022 and July 2024, and all of them underwent DCE-MRI scan and had had histology-proven diagnosis. Quantitative parameters of DCE-MRI , e.g., volume transfer constant (Ktrans), reverse rate constant (Kep)and extracellular volume fraction (Ve) were recorded, and receiver operating characteristic (ROC) curveswere applied to evaluate diagnostic efficacy of DCE-MRI scan. Results Of 103 patients with FLL in our series, histo-pathological examination made diagnosis of hepatocellular carcinoma(HCC)in 64 cases, intrahepatic cholangiocarcinoma (ICC) in 12 cases, focal nodular hyperplasia (FNH) in 8 cases and hepatic hemangioma (HH) in 19 cases; proportions of lesions with rich blood supply at arterial phase of DCE-MRI in HCC group and in HH group were 90.6% and 100.0%, both much higher than 41.7% in ICC group or 75.0% in FNH group (P＜0.05); Ktrans, Kep and Ve in HH were (0.4±0.1),(0.5±0.1) and (0.7±0.2), and were (0.3±0.1),(0.4±0.1) and (0.5±0.1) in FNH, all significantly lower than [(0.7±0.2),(0.9±0.3) and (1.1±0.4), respectively, P＜0.05] in HCC or [(0.6±0.2),(0.8±0.3) and (1.0±0.3), respectively, P＜0.05] in ICC; sensitivity, specificity and accuracy by DCE-MRI in diagnosing HCC were 93.8%, 92.3% and 93.2%, in diagnosing ICC were 83.3%, 95.6%and 94.2%, in diagnosing FNH were 75.0%, 97.9%and 96.1%, and in diagnosing HH were 89.5%, 98.8% and 97.1%, very promising consistency with histo-pathological diagnosis (all kappa>0.7). Conclusion Quantitative DCE-MRI scan has a high diagnostic efficacy in evaluating intrahepatic FLL, which might help clinicians make an appropriate medical intervention choice.

Key words: Focal liver lesion, Hepatoma, Dynamic contrast-enhanced magnetic resonance imaging, Quantitative parameters, Diagnosis

刘静芳, 张苏波, 丁军明, 杨卫健. 定量动态增强MRI诊断肝脏局灶性病变价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 776-779.

Liu Jingfang, Zhang Subo, Ding Junming, et al. Diagnostic performance of quantitative dynamic contrast-enhanced magnetic resonance imaging in patients with focal liver lesions[J]. Journal of Practical Hepatology, 2025, 28(5): 776-779.

参考文献

[1] Wei Y, Yang M, Zhang M, et al. Focal liver lesion diagnosis with deep learning and multistage CT imaging. Nat Commun,2024,15(1):7040-7043.
[2] Stollmayer R, Budai BK, Rónaszéki A, et al. Focal liver lesion MRI feature identification using efficient net and MONAI: a feasibility study. Cells,2022,11(9):1558-1560.
[3] Ma L, Wang L, Khatib SA, et al. Single-cell atlas of tumor cell evolution in response to therapy in hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Hepatol,2021, 75(6):1397-1408.
[4] Li W, Li R, Zhao X, et al. Differentiation of hepatocellular carcinoma from hepatic hemangioma and focal nodular hyperplasia using computed tomographic spectral imaging. J Clin Transl Hepatol,2021,9(3):315-323.
[5] Mejia JC, Pasko J. Primary liver cancers: intrahepatic cholangiocarcinoma and hepatocellular carcinoma. Surg Clin North Am,2020,100(3):535-549.
[6] Sun Y, Zhu Q, Huang M, et al. Liver DCE-MRI registration based on sparse recovery of contrast agent curves. Med Phys,2021,48(11):6916-6929.
[7] 谢晶美,刘浩,李安,等.动态增强MRI定量参数术前评估原发性肝癌患者临床分期研究.实用肝脏病杂志,2024,27(2):255-258.
[8] Chen BB, Lin ZZ, Shao YY, et al. Early changes in DCE-MRI biomarkers may predict survival outcomes in patients with advanced hepatocellular carcinoma after sorafenib failure: two prospective phase II trials. Cancers (Basel),2021,13(19):4962-4965.
[9] Gao L, Wang W, Meng X, et al. TPA: Two-stage progressive attention segmentation framework for hepatocellular carcinoma on multi-modality MRI. Med Phys,2024,51(7): 4936-4947.
[10] Kaissis GA, Lohöfer FK, Hörl M, et al. Combined DCE-MRI- and FDG-PET enable histopathological grading prediction in a rat model of hepatocellular carcinoma. Eur J Radiol,2020,5(124):1084-1088.
[11] Alareer HSN, Jasim H, Dinar A. Dynamic contrast enhanced-MRI and apparent diffusion coefficient quantitation for differentiate hepatocellular carcinoma from hepatocellular adenoma. Asian Pac J Cancer Prev,2024,25(3):931-937.
[12] 丹巴玉珍,程盼.增强MRI检查诊断HCC价值研究.实用肝脏病杂志,2024,27(6): 911-914.
[13] Yang J, Dong X, Jin S, et al. Radiomics model of dynamic contrast-enhanced MRI for evaluating vessels encapsulating tumor clusters and microvascular invasion in hepatocellular carcinoma. Acad Radiol,2024,7(17):1076-1078.
[14] 曾旺,蔡晓曼,葛尚.肝内胆管细胞癌与肝细胞癌病灶MRI增强扫描表现差异分析.实用肝脏病杂志,2024,27(6):907-910.
[15] Song Q, Guo Y, Yao X, et al. Comparative study of evaluating the microcirculatory function status of primary small HCC between the CE (DCE-MRI) and non-CE (IVIM-DWI) MR perfusion imaging. Abdom Radiol,2021,46(6):2575-2583.
[16] Dong X, Yang J, Zhang B, et al. Deep learning radiomics model of dynamic contrast-enhanced MRI for evaluating vessels encapsulating tumor clusters and prognosis in hepatocellular carcinoma. J Magn Reson Imaging,2024,59(1):108-119.
[17] Zhou Y, Zhou G, Zhang J, et al. DCE-MRI based radiomics nomogram for preoperatively differentiating combined hepatocellular-cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma. Eur Radiol,2022,32(7):5004-5015.
[18] Barzegar M, Taghiloo A, Abedi R. Editorial for "the early-enhancing hepatic vein: differentiating focal nodular hyperplasia and hepatic adenoma with pathologic validation in MRI". J Magn Reson Imaging,2023,58(4):1198-1199.
[19] Kania LM, Dave J, Guglielmo FF, et al. The early-enhancing hepatic vein: differentiating focal nodular hyperplasia and hepatic adenoma with pathologic validation in MRI. J Magn Reson Imaging,2023,58(4):1191-1197.
[20] Brancato V, Garbino N, Salvatore M, et al. MRI-based radiomic features help identify lesions and predict histopathological grade of hepatocellular carcinoma. Diagnostics,2022,12(5): 1085-1088.
[21] 贾素兰,卢昊宁,杜静波.肝脏小血管瘤患者MRI动态增强和弥散成像表现特征.实用肝脏病杂志,2024,27(1):113-116.
[22] Liu Z, Yi L, Chen J, et al. Comparison of the clinical and MRI features of patients with hepatic hemangioma, epithelioid hemangioendothelioma, or angiosarcoma. BMC Med Imaging,2020,20(1):71-75.

定量动态增强MRI诊断肝脏局灶性病变价值研究^*

Diagnostic performance of quantitative dynamic contrast-enhanced magnetic resonance imaging in patients with focal liver lesions

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