Differential diagnostic value of abdominal magnetic resonance enhancement combined with DWI technique on benign and malignant liver tumors
-
摘要:
目的探讨腹部MRI动态增强扫描（DCEI）结合弥散加权成像（DWI）技术对肝脏良恶性肿瘤的鉴别诊断价值。 方法回顾性分析2019年3月~2020年3月我放射科核磁室同北京大学第一医院核磁室合作检查64例（91个病灶）肝肿瘤患者的临床资料，经手术病理证实为恶性病灶61个、良性病灶30个。患者均行MRI DCEI及DWI检查，观察肝脏病灶在上述序列上的表现特征，评估MRI DCEI联合DWI对肝脏良恶性肿瘤的鉴别诊断价值。 结果恶性病灶中DCEI表现为快进快出、DWI呈高信号者占比大于良性病灶（P < 0.05）。DCEI联合DWI诊断灵敏度、准确度高于DCEI、DWI单独诊断（P < 0.05）；特异度与DCEI诊断差异无统计学意义（P>0.05），但高于DWI（P < 0.05）。 结论良性、恶性肝肿瘤DCEI、DWI表现特征具有差异，DCEI联合DWI诊断肝肿瘤可显著提高诊断准确度和灵敏度，对肝肿瘤良恶性鉴别诊断有重要价值。 Abstract:ObjectiveTo explore the differential diagnostic value of abdominal MRI dynamic contrast-enhanced imaging (DCEI) combined with diffusion- weighted imaging (DWI) on benign and malignant liver tumors. MethodsThe clinical data of 64 patients (91 lesions) with liver tumors from March 2019 to March 2020 in our hospital were retrospectively analyzed. Sixty-one malignant lesions and 30 benign lesions were confirmed by surgical pathology. All patients were given MRI DCEI and DWI, and the features of findings of liver lesions in the above sequences were observed, and the differential diagnostic value of MRI DCEI combined with DWI on benign and malignant liver tumors was evaluated. ResultsThe proportion of patients with fast in and fast out in DCEI and high signal in DWI of malignant lesions was higher than that of benign lesions (P < 0.05). The sensitivity and accuracy of DCEI combined with DWI were higher than those of DCEI or DWI (P < 0.05). The specificity was not significantly different from that of DCEI (P>0.05), but it was higher than that of DWI (P < 0.05). ConclusionThe features of DCEI and DWI findings are significantly different in benign and malignant liver tumors. DCEI combined with DWI can significantly improve the diagnostic accuracy and sensitivity in the diagnosis of liver tumors. -
图 1 肝脏良恶性肿瘤典型DCEI及DWI图像
A~B: 患者男, 65岁; A: HCC DCEI图像; B: DWI图像, MRI示肝右叶类圆形结节, T1WI低信号, T2WI稍高信号, DCEI呈快进快出, DWI高信号, 诊断为HCC; C~D: 患者男, 59岁, MRI示肝内多个长T1、T2异常信号, 肝右叶可见裂隙征, DCEI（C）呈填充式强化，延迟期仍为高信号, DWI（D）高信号, 诊断为肝血管瘤.
Figure 1. Typical DCEI and DWI images of benign and malignant liver tumors.
表 1 肝脏病灶的MRI DCEI、DWI表现特征
Table 1. Findings features of MRI DCEI and DWI of liver lesions [n(%)]
病灶类型 DCEI DWI 快进快出 不符合快进快出 高信号 低或等信号 恶性（n=61） 49（80.33） 12（19.67） 59（96.72） 2（3.28） 良性（n=30） 5（16.67） 25（83.33） 24（80.00） 6（20.00） χ2 33.779 5.082 P 0.000 0.024 
下载: 导出CSV
表 2 DCEI诊断肝肿瘤良恶性价值
Table 2. Value of DCEI in diagnosing benign and malignant liver tumors (n)
诊断方法 病理诊断 恶性 良性 合计 DCEI 恶性 44 7 51 良性 17 23 40 合计 61 30 91
下载: 导出CSV
表 3 DWI诊断肝肿瘤良恶性价值
Table 3. Value of DWI in diagnosing benign and malignant liver tumors (n)
诊断方式 病理诊断 恶性 良性 合计 恶性 53 15 68 DWI 良性 8 15 23 合计 61 30 91
下载: 导出CSV
表 4 DCEI联合DWI诊断肝肿瘤良恶性价值
Table 4. Value of DCEI combined with DWI in diagnosing benign and malignant liver tumors (n)
诊断方式 病理诊断 恶性 良性 合计 恶性 59 7 66 DCEI联合DWI 良性 2 23 25 合计 61 30 91
下载: 导出CSV
-
[1] 张爽, 王锋, 孟庆玲, 等. 原发性肝癌患者流行病学与乙型肝炎病毒感染调查[J]. 中国疫苗和免疫, 2018, 24(2): 133-6, 151. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJM201802003.htm [2] 张海容, 张婕, 宣绍成, 等. CT联合MRI对老年原发性肝癌经导管肝动脉化疗栓塞术后预后评价探究[J]. 中国医学前沿杂志: 电子版, 2018, 10(7): 88-91. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY201807020.htm [3] Park MY, Choi JI, Yu H, et al. Computed diffusion weighted imaging of the liver using extrapolation technique in patients who underwent liver transplantation with hepatocellular carcinomas: initial experience and feasibility study[J]. J Comput Assist Tomogr, 2018, 42(4): 632-6. doi: 10.1097/RCT.0000000000000720 [4] 闫斌, 金晨望, 梁秀芬, 等. DWI定量测量鉴别肝结节良恶性[J]. 现代肿瘤医学, 2017, 25(23): 3843-8. doi: 10.3969/j.issn.1672-4992.2017.23.032 [5] Huh J, Park J, Kim KW, et al. Optimal phase of dynamic computed tomography for reliable size measurement of metastatic neuroendocrine tumors of the liver: comparison between pre- and postcontrast phases[J]. Korean J Radiol, 2018, 19(6): 1066-76. doi: 10.3348/kjr.2018.19.6.1066 [6] 高云, 郑晓林, 杨沛钦, 等. 探讨MRl连续动态增强对肝癌的诊断价值及与常规CT多期增强的比较[J]. 中国CT和MRI杂志, 2017, 15(5): 92-5, 111. doi: 10.3969/j.issn.1672-5131.2017.05.028 [7] 史爽, 姜涛, 雷杰, 等. 腹部磁共振弥散加权成像(DWI)技术在对肝脏良、恶性肿瘤鉴别中的应用价值[J]. 中国继续医学教育, 2017, 9(2): 81-2. doi: 10.3969/j.issn.1674-9308.2017.02.043 [8] 陈静静, 石祥龙, 华辉, 等. 磁共振动态增强扫描定量指标诊断肝脏占位性病变[J]. 中国医学影像技术, 2015, 31(1): 72-6. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201501029.htm [9] 皋月娟, 李猛, 陈敏, 等. 超声造影成像技术在早期肝癌诊断中的临床应用价值[J]. 中国医学前沿杂志: 电子版, 2017, 9(1): 87-90. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY201701019.htm [10] 王鹏, 苟晓光, 李堃, 等. MRI扫描联合血清GP73、AFP水平检测对乙型肝炎肝硬化背景小肝癌诊断的研究[J]. 中国医学前沿杂志: 电子版, 2017, 9(7): 152-6. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY201707019.htm [11] 关闯. 肝脏良恶性病变磁共振动态增强扫描定量参数的测定及其临床价值[J]. 海南医学院学报, 2019, 25(1): 73-6, 80. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYY201901019.htm [12] Hopkinson G, Lockwood P, Dolbear G. Evaluation of an equilibrium phase free-breathing dynamic contrast-enhanced MRI prototype sequence compared to traditional breath-held MRI acquisition in liver oncology patients[J]. Radiography (Lond), 2018, 24(3): 211-8. doi: 10.1016/j.radi.2018.01.001 [13] Komatsu D, Yamada A, Suzuki T, et al. Compartment model analysis of intravenous contrast-enhanced dynamic computed tomography in hepatic hemodynamics: a validation study using intra-arterial contrast-enhanced computed tomography[J]. Hepatol Res, 2018, 48 (10): 829-38. doi: 10.1111/hepr.13073 [14] 邢腾龙, 成戈, 周智鹏, 等. MRI动态增强定量参数对肝细胞癌和肝良性肿瘤鉴别诊断的价值[J]. 实用放射学杂志, 2016, 32(3): 366-9, 379. doi: 10.3969/j.issn.1002-1671.2016.03.010 [15] 杨耀文, 王志涛, 王颖. MR DWI在肝癌TACE术后评估中的应用研究[J]. 实用放射学杂志, 2018, 34(4): 600-2, 605. doi: 10.3969/j.issn.1002-1671.2018.04.030 [16] 孙维高, 卢定友. DWI序列ADC值联合LAVA在肝脏恶性肿瘤诊断中的应用价值探讨[J]. 实用肝脏病杂志, 2017, 20(4): 447-50. doi: 10.3969/j.issn.1672-5069.2017.04.017 [17] Barabasch A, Heinzel A, Bruners P, et al. Diffusion-weighted MRI is superior to PET/CT in predicting survival of patients undergoing 90Y radioembolization of hepatic metastases[J]. Radiology, 2018, 288(3): 764-73. doi: 10.1148/radiol.2018170408 [18] 蔡恩明. 磁共振弥散加权成像技术在肝脏良、恶性肿瘤中的鉴别诊断价值[J]. 实用临床医药杂志, 2018, 22(1): 71-3. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201801022.htm [19] 韩铮, 刘爱连, 刘泽群, 等. DWI不同指数模型在肝细胞癌及肝血管瘤鉴别诊断中的应用价值[J]. 磁共振成像, 2017, 8(7): 519-25. https://www.cnki.com.cn/Article/CJFDTOTAL-CGZC201707013.htm [20] Roth CG, Marzio DHD, Guglielmo FF. Contributions of magnetic resonance imaging to gastroenterological practice: MRIs for GIs[J]. Dig Dis Sci, 2018, 63(5): 1102-22. doi: 10.1007/s10620-018-4991-x [21] 徐安波, 丁朝鹏, 孟凡杰, 等. 磁共振动态增强和DWI在肝结节性病变与小肝癌诊断中的应用分析[J]. 医学影像学杂志, 2017, 27(5): 954-7. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ201705049.htm [22] 刘金有, 汤立华, 范高洁, 等. DWI对肝脏肿瘤的临床分析[J]. 分子影像学杂志, 2015, 38(4): 338-41. doi: 10.3969/j.issn.1674-4500.2015.04.10 -
点击查看大图
图(1) / 表(4)
计量
- 文章访问数: 832
- HTML全文浏览量: 392
- PDF下载量: 29
- 被引次数: 0
