CT和MRI多期动态增强扫描诊断乙型肝炎肝硬化背景下原发性肝癌价值研究*

doi:10.3969/j.issn.1672-5069.2026.03.025

摘要/Abstract

摘要： 目的探讨CT和磁共振成像(MRI)多期动态增强扫描诊断乙型肝炎肝硬化背景下原发性肝癌(PLC)的价值。方法 2022年1月～2025年1月我院收治的108例乙型肝炎肝硬化患者,经CT和MRI多期动态增强扫描发现肝内存在局灶性病变。常规检测血清甲胎蛋白(AFP)和异常凝血酶原(PIVKA-Ⅱ)水平。以术后组织或穿刺活检组织病理学检查诊断为“金标准”,应用受试者工作特征曲线(ROC)分析诊断效能。结果经病理学检查,在108例乙型肝炎肝硬化患者中,诊断肝细胞癌(HCC)者70例(64.8%)和局灶性结节性增生(FNH)者38例(35.2%);HCC组血清AFP和PIVKA-II水平分别为(321.3±50.8)ng/mL和(458.6±136.5)mAU/mL,均显著高于FNH组【分别为(8.2±1.1)ng/mL和(48.6±5.1)mAU/mL,P<0.05】;CT检查诊断恶性病变64例,MRI诊断69例;CT和MRI联合血清AFP或/和PIVKA-II水平诊断HCC的AUC为0.976 (95%CI:0.926～0.996),其灵敏度为100.0%,特异度为94.7%,准确度为100.0%。结论应用CT和MRI多期动态增强扫描联合血清AFP或/和PIVKA-Ⅱ水平判断乙型肝炎肝硬化患者肝内占位性病变性质的准确性高,临床应用价值大,需要不断积累经验,做好早期诊断。

关键词: 原发性肝癌, 肝硬化, CT扫描, MRI扫描, 甲胎蛋白, 异常凝血酶原, 诊断

Abstract: Objective The aim of this study was to investigate the diagnostic performance of CT and magnetic resonance imaging (MRI) scan in combination with serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) PIVKA-II levels in patients with hepatitis B-induced liver cirrhosis (LC) with space-occupying lesions(SOL). Methods A total of 108 patients with hepatitis B-induced LC were encountered in our hospital between January 2022 and January 2025, and all had intrahepatic SOL as showed by CT and/or MRI. Serum AFP and PIVKA-II levels were routinely assayed. The diagnosis was proven by histo-pathological examination based on fine needle aspiration or post-operational specimen. Receiver operating characteristic (ROC) curves was applied to evaluate the diagnostic efficacy. Results Of the108 patients with LC, histo-pathological examination diagnosed hepatocellular carcinoma (HCC) in 70 cases(64.8%) and focal nodular hyperplasia (FNH) in 38 cases (35.2%); serum AFP and PIVKA-II levels in patients with HCC were(321. 3±50.8)ng/mL and (458.6±136.5)mAU/mL, both significantly higher than [(8.2±1.1)ng/mL and (48.6±5.1)mAU/mL, respectively, P<0.05]in those with FNH; in our series, CT found malignant lesions in 64 cases and MRI diagnosed in 69 cases; the AUC was 0.976 (95%CI:0.926-0.996), with sensitivity of 100.0%, specificity of 94.7% and accuracy of 100.0%, when CT and MRI in combination with serum AFP and/or PIVKA-II levels in diagnosing HCC. Conclusion Multi-phase CT and MRI dynamic contrast-enhanced scan in combination with serum special tumor markers in differentiating intrahepatic SOL has a satisfactory efficacy in patients with hepatitis B-induced LC, which warrants multiple center investigation.

Key words: Hepatoma, Liver cirrhosis, CT dynamic contrast-enhanced scan, MRI, Alpha-fetoprotein, Protein induced by vitamin K absence or antagonist-II, Diagnosis

钱梦姣, 孙研俊, 钟瑶. CT和MRI多期动态增强扫描诊断乙型肝炎肝硬化背景下原发性肝癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(3): 417-420.

Qian Mengjiao, Sun Yanjun, Zhong Yao. Diagnostic performance of CT and MRI scan in combination with serum AFP and PIVKA-II levels in patients with hepatitis B-induced liver cirrhosis with space-occupying lesions[J]. Journal of Practical Hepatology, 2026, 29(3): 417-420.

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CT和MRI多期动态增强扫描诊断乙型肝炎肝硬化背景下原发性肝癌价值研究^*

Diagnostic performance of CT and MRI scan in combination with serum AFP and PIVKA-II levels in patients with hepatitis B-induced liver cirrhosis with space-occupying lesions

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