高场磁共振多b值弥散加权成像鉴别诊断肝血管瘤与肝细胞癌价值探讨*

doi:10.3969/j.issn.1672-5069.2023.01.027

Abstract

Abstract: Objective The aim of this study was to investigate the differential diagnosis of hepatic hemangioma (HH) and hepatocellular carcinoma (HCC) by multi-b-value diffusion-weighted imaging (DWI) of high-field magnetic resonance (MR). Methods 85 patients with focal space-occupying liver lesions (FLL) were encountered in our hospital between June 2019 and May 2021, and all underwent high-field magnetic resonance and the apparent diffusion coefficient (ADC) was recorded. All patients received hepatectomy, and the histopathological examination was performed. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to testify the differential diagnosis performance of ADC value for HH and HCC. Results The results of pathological examination post-operationally showed that among the 85 patients with FLL, the HH was found in 28 cases (32.9%), the focal liver nodular hyperplasia (FNH) was found in 18 cases (21.2%) and the HCC was found in 39 cases (45.9%); the ADC of cancerous foci at b=50 s/mm², b=400 s/mm² and b=1000 s/mm² were (2.41±0.20)×10^-3/mm²/s, (2.02±0.19)×10^-3/mm²/s and (1.73±0.15)×10^-3/mm²/s, the ADC of FNH foci were (2.43±0.31)×10^-3/mm²/s, (2.05±0.21)×10^-3/mm²/s and (2.01±0.18)×10^-3/mm²/s, all significantly lower than [(2.63±0.35)×10^-3/mm²/s, (2.46±0.32)×10^-3/mm²/s and (2.25±0.23)×10^-3/mm²/s, respectively, P＜0.05] in HH foci; the ROC was drawn based on ADC at b=1000 s/mm², and the ADC=1.73×10^-3/mm²/s was set as the optimal cut-off-value for differential diagnostic of HH and HCC, the performance is excellent with the AUC(95%CI) of 0.727(0.581-0.844, P＜0.05), the sensitivity of 80.0% and the specificity of 75.9%. Conclusion The high-field magnetic resonance imaging has a great importance in the differential diagnosis of hepatic hemangioma and hepatocellular carcinoma, and we recommend the ADCs at b equal to 1000s/mm², which needs further clinical investigation.

Key words: Hepatoma, Hepatic hemangioma, High-field magnetic resonance, Diffusion-weighted imaging, Apparent diffusion coefficient, Differential diagnosis

Gao Xiangrui, Liu Hongyan, Zhang Huai, et al. Differential diagnosis of hepatic hemangioma and hepatocellular carcinoma by multi-b-value diffusion-weighted imaging of high-field magnetic resonance[J]. Journal of Practical Hepatology, 2023, 26(1): 104-107.

References

[1] Luo Y, Yue W, Li Z, et al. Contrast-enhanced ultrasound and its differential diagnosis in 21 patients with intrahepatic space-occupying lesions under the background of fatty liver. Ann Palliat Med,2021,10(3):3097-3104.
[2] Thyagarajan M S, Sharif K. Space occupying lesions in the liver. Indian J Pediatr,2016,83(11):1291-1302.
[3] Zou X, Luo Y, Morelli J N, et al. Differentiation of hepatocellular carcinoma from intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma in high-risk patients matched to MR field strength: diagnostic performance of LI-RADS version 2018. Abdom Radiol (NY),2021,46(7):3168-3178.
[4] Greenwood H I, Freimanis R I, Carpentier B M, et al. Clinical breast magnetic resonance imaging: technique, indications, and future applications. Semin Ultrasound CT MR,2018,39(1):45-59.
[5] 黄成. 2016年欧洲肝病学会临床实践指南:肝脏良性肿瘤的管理. 临床肝胆病杂志,2016,32(8):1439-1445.
[6] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版). 中华消化外科杂志,2020,19(1):1-20.
[7] Inglese M, Fleysher L, Oesingmann N, et al. Clinical applications of ultra-high field magnetic resonance imaging in multiple sclerosis. Expert Rev Neurother,2018,18(3):221-230.
[8] 程华才,陈家祥,马岩,等. 弥散加权成像在肝脏局灶性病变中的应用. 中国CT和MRI杂志,2011,9(2):49-51.
[9] Hori M, Kamiya K, Murata K. Technical basics of diffusion-weighted imaging. Magn Reson Imaging Clin N Am,2021,29(2):129-136.
[10] Surov A, Pech M, Omari J, et al. Diffusion-weighted imaging reflects tumor grading and microvascular invasion in hepatocellular carcinoma. Liver Cancer,2021,10(1):10-24.
[11] Li Z, Mao Y, Huang W, et al. Texture-based classification of different single liver lesion based on SPAIR T2W MRI images. BMC Med Imaging,2017,17(1):42.
[12] 汪建华,王玉涛,马小龙,等. 磁共振成像在自身免疫性胰腺炎诊断与鉴别诊断中的价值. 中华消化杂志,2014,34(4):260-265.
[13] Lahrsow M, Albrecht M H, Bickford M W, et al. Predicting treatment response of colorectal cancer liver metastases to conventional lipiodol-based transarterial chemoembolization using diffusion-weighted MR imaging: value of pretreatment apparent diffusion coefficients (ADC) and ADC changes under therapy. Cardiovasc Intervent Radiol,2017,40(6):852-859.
[14] Xu Q, Huang Y, Shi H, et al. Sunitinib versus sorafenib plus transarterial chemoembolization for inoperable hepatocellular carcinoma patients. J Buon,2018,23(1):193-199.
[15] Tokgoz O, Unlu E, Unal I, et al. Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver. Afr Health Sci,2016,16(1):227-233.
[16] Harada T L, Saito K, Araki Y, et al. Prediction of high-stage liver fibrosis using ADC value on diffusion-weighted imaging and quantitative enhancement ratio at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI at 1.5 T. Acta Radiol,2018,59(5):509-516.
[17] Poon R T, Ngan H, Lo C M, et al. Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol,2016,73(2):109-114.
[18] Ranjpour M, Wajid S, Jain SK.. Elevated expression of cytosolic phospholipase A2 delta is associated with lipid metabolism dysregulation during hepatocellular carcinoma progression.Cell J, 2020,22(1):17-22.
[19] Kumar P, Agarwal A, Singh AK, et al. Antineoplastic properties of zafirlukast against hepatocellular carcinoma via activation of mitochondrial mediated apoptosis. Regul Toxicol Pharmacol, 2019,109:104489.
[20] Park M J, Kim Y K, Lee M W, et al. Small hepatocellular carcinomas: improved sensitivity by combining gadoxetic acid-enhanced and diffusion-weighted MR imaging patterns. Radiology,2012,264(3):761-770.
[21] Erturk S M, Ichikawa T, Kaya E, et al. Diffusion tensor imaging of cysts, hemangiomas, and metastases of the liver. Acta Radiol,2014,55(6):654-660.
[22] Xiaotong S, Jutong S, Hua H, et al. Hsa_circ_0070269 inhibits hepatocellular carcinoma progression through modulating miR-182/NPTX1 axis. Biomed Pharmacother. 2019,120:109497.
[23] 钟锐,张敏,何浩强,等. B值800s/mm2磁共振弥散加权成像(DWI)在肝脏占位性病变鉴别诊断中的应用. 中国CT和MRI杂志,2011,9(6):1-4.

Differential diagnosis of hepatic hemangioma and hepatocellular carcinoma by multi-b-value diffusion-weighted imaging of high-field magnetic resonance

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Jiang Huizhen, Chen Jun, Chen Chunmei, et al. Performance of quantitative parameters by dynamic contrast-enhanced magnetic resonance imaging in the diagnosis of benign and malignant hepatic space-occupying lesions [J]. Journal of Practical Hepatology, 2023, 26(1): 100-103.
[2]	Ding Haibin, Zhang Xin, Li Ya, et al. TACE with sequential microwave ablation followed by oral sorafenib maintenance in treatment of patients with large hepatocellular carcinoma [J]. Journal of Practical Hepatology, 2023, 26(1): 108-111.
[3]	Peng Yu, Li Haitao, Yang Wenli, et al. Clinical efficacy of PD-1 inhibitor and lenvatinib in the treatment of elderly patients with advanced primary liver cancer [J]. Journal of Practical Hepatology, 2023, 26(1): 112-115.
[4]	Du Shangyun, Weng Li, Wu Min. Clinical observation of camrelizumab therapy after TACE in the treatment of patients with advanced primary liver cancer [J]. Journal of Practical Hepatology, 2023, 26(1): 116-119.
[5]	Zhang Zixia, Li Delin, Zhang Guoliang. Clinical efficacy of Yipi Yanggan Decoction after radiofrequency ablation in the treatment of patients with primary liver cancer [J]. Journal of Practical Hepatology, 2023, 26(1): 142-144.
[6]	He Xiaojin, Li Dan, Zhou Qing, et al.. Expression of hepatitis B virus X protein and suppressor of cytokine signaling-1 in L02 cells in vitro [J]. Journal of Practical Hepatology, 2022, 25(6): 772-775.
[7]	Zhang Yaohui, Zheng Zhangzeng, Gao Xing, et al.. Contrast-enhanced ultrasound time-intensity curve in assessment of liver nodules in cirrhotic patients [J]. Journal of Practical Hepatology, 2022, 25(6): 861-864.
[8]	Mao Yueqin, Zhang Hongxia, Song Haiyan, et al.. Clinical efficacy of auxiliary DutanyuPixu Formulae therapy after TACE in the treatment of patients with primary liver cancer [J]. Journal of Practical Hepatology, 2022, 25(6): 873-876.
[9]	Wu Zhenghong, Wu Dongqiu, Liu Sibin. Performance of DCE-MRI in diagnosis and evaluation of TACE efficacy in patients with primary liver cancer [J]. Journal of Practical Hepatology, 2022, 25(6): 881-884.
[10]	Lan Sirong, Xu Jiwei, Zhang Yaoming, et al.. Guidance of real-time contrast-enhanced ultrasonography and 3D ultrasound fusion imaging for ablation area in patients with primary liver cancer during microwave ablation therapy [J]. Journal of Practical Hepatology, 2022, 25(6): 889-892.
[11]	Li Ji, Zhou Zhongsong, Gao Yufeng, et al.. Short-term clinical efficacy of microwave ablation under the guidance of ultrasound fusion imaging in the treatment of patients with small primary liver cancer [J]. Journal of Practical Hepatology, 2022, 25(5): 698-701.
[12]	Fan Shunke, Wang Guiluo,Yi Xiaoyan. Different dosage of sevoflurane and propofol combination venous-inhalation anesthesia in patients with primary liver cancer undergoing radical hepatectomy [J]. Journal of Practical Hepatology, 2022, 25(5): 702-705.
[13]	Du Lianjiang, Li Jingtao, Cui Jie. Caspase-3, DcR3 expression and SNHG12 mRNA level in cancerous tissues in patients with hepatocellular carcinoma [J]. Journal of Practical Hepatology, 2022, 25(5): 706-709.
[14]	Zhang Kai, Liu Peipei, Rao Shilei, et al.. Survival rates in patients with primary liver cancer and different gross tumor volumes after radiotherapy [J]. Journal of Practical Hepatology, 2022, 25(5): 710-713.
[15]	Li Qinghan, Zhen Zuojun, He Yintao. Short-term efficacy of TACE, RFA, anti-PD-1 antibody and apatinib combination in the treatment of patients with postoperative recurrent hepatocellular carcinoma [J]. Journal of Practical Hepatology, 2022, 25(5): 714-717.