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作 者:钱海珍 林光武[1] 嵇鸣[1] 卢晨[2] 李翠仙[3]
机构地区:[1]复旦大学附属华东医院放射科,上海200040 [2]复旦大学附属华东医院病理科,上海200040 [3]复旦大学附属中山医院放射科,上海200040
出 处:《中华肿瘤杂志》2015年第6期445-450,共6页Chinese Journal of Oncology
摘 要:目的:探讨肝脏孤立性乏血供结节的磁共振成像( MRI)特点及良恶性鉴别方法。方法收集经手术、穿刺活检或随访确诊的135例肝脏孤立性乏血供结节(直径≤3 cm)患者的资料,其中恶性组55例(结节型胆管细胞癌29例,转移瘤26例),良性组80例(炎性肌纤维母细胞瘤48例,不典型肝血管瘤32例)。所有病灶均行MRI平扫和动态增强扫描,分析病灶的MRI平扫和动态增强扫描表现。并对3名诊断科医师研究前后2次阅片的诊断结果进行受试者操作特征( ROC)曲线分析。结果病灶是否靠近肝包膜、边界是否清楚、T2WI上瘤内信号的高低、瘤体信号是否均匀、病灶边缘和中心的强化方式及动态强化规律在良恶性肝脏孤立性乏血供结节之间的分布差异均有统计学意义(均P<0.05)。3名诊断科医师第1次阅片的ROC曲线下面积为0.678±0.047,第2次阅片的ROC曲线下面积为0.920±0.022,差异有统计学意义(Z=5.22,P<0.05)。结论肝脏孤立性乏血供结节的MRI平扫和动态增强扫描表现各有特点,结合临床病史、实验室检查,可对其进行良恶性判定和较准确的诊断。Objective The purpose of this study was to compare MRI findings of solitary hypovascular hepatic nodules, benign and malignant, to identify their MRI characteristics. Methods We retrospectively assessed solitary hypovascular hepatic nodules ≤3 cm in 135 patients, among them there were 55 malignant nodules [29 peripheral nodules of cholangiocarcinoma, PCC, and 26 hepatic metastases, HM] and 80 benign nodules [ 48 inflammatory myofibroblastic tumors, IMT, and 32 hepatic hemangioma, HG] , proved by surgery, biopsy or follow-up imaging. Unenhanced and dynamic enhanced MRI findings of the 135 patients were analyzed retrospectively. Statistical analysis included Chi-square test or Fisher′s exact test, and receiver operating characteristic ( ROC) curve. Results There was significant difference ( P〈0.05) between the malignant group and benign group in terms of location, margin, T2WI signal intensity, heterogeneity or homogeneity of the nodule, and type and degree of peritumoral and intratumoral enhancement. Area under the curve at the first film reading by three radiologists was 0.678±0.047, 0.920± 0.022 at the second time, and there was a significant difference ( Z= 5. 22, P〈0. 05 ) between them. Conclusions Our data indicated that solitary hypovascular hepatic nodules show unenhanced and dynamic enhanced MRI features. Therefore, MR imaging combined with clinical and biochemical data does provide reliable information for a proper diagnosis of such hepatic lesions and differentiation of malignant from benign nodules.
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