多b值DWI联合DCE-MRI在肝硬化异型增生结节与小肝癌鉴别诊断中的价值  

Value of Multiple b Value DWI Combined with DCE-MRI in the Differential Diagnosis of Hepatic Cirrhosis Dysplasia Nodules and Small Liver Cancer

作　　者：张少平[1] 郭冰冰 麻海龙[1] 杨子江[1] 朱聪辉[1] ZHANG Shao-ping;GUO Bing-bing;MA Hai-long;YANG Zi-jiang;ZHU Cong-hui(Department of Imaging,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian Province,362000 China)

机构地区：[1]福建医科大学附属泉州第一医院影像科,福建泉州362000

出　　处：《中外医疗》2018年第33期1-6,共6页China & Foreign Medical Treatment

摘　　要：目的探讨多b值扩散加权成像联合DCE-MRI在肝硬化异型增生结节与小肝癌鉴别诊断中的可行性和应用价值,为肝癌的预防和早期诊断提供参考依据。方法方便收集该院2012年3月—2017年9月行MRI检查并经病理证实的肝脏异型增生结节17例(18个病灶)及小肝癌18例(20个病灶)患者的资料,所有患者行常规MRI平扫、多b值DWI及DCE-MRI检查,对图像结果统计分析获得DN和SHCC对背景肝实质信号强度比值及ADC值,最后利用ROC曲线分析b值显示病灶的最佳参数。结果 18个DN,T1WI(同相位)呈高或稍高信号10个,等信号7个,低信号1个;压脂T2WI呈低或稍低信号12个(占65.0%),等信号5个,高信号1个;DWI呈等信号7个,高信号1个,低或稍低信号10个(占57.7%);动态增强扫描1个病灶动脉期呈明显强化,门脉期及平衡期强化程度降低,仍呈高信号,17个病灶动脉期呈相对高信号9个,等信号8个,门静脉期呈等信号11个,稍低信号6个,平衡期呈等信号4个,稍低信号13个(占73.0%),12个(占65.0%)DN周边见网格状强化;DWI联合DCE-MRI诊断DN,随b值从100 s/mm2递增至800 s/mm2的变化,图像信号强度及信噪比呈逐渐降低,DN结节呈稍低信号为主,以b值600 s/mm2时病灶显示最佳。20个HCC,T1WI(同相位)呈低或稍低信号12个,等信号6个,高信号2个,反相信号降低2个;压脂T2WI呈稍高信号14个(占70.0%),呈等、稍高混杂信号5个,稍低信号1个;DWI呈稍高或高信号17个(占85.0%),等信号3个;动态增强扫描动脉期17个(占85.0%)病灶见明显强化,门静脉期呈高、低混杂信号18个,等信号2个,平衡期呈低或稍低信号19个,等信号1个,平衡期15个(占75.0%)病灶见假包膜形成并强化;DWI联合DCE-MRI诊断SHCC,随b值从100 s/mm2递增至800 s/mm2的变化,图像信号强度及信噪比呈逐渐降低,以b值600 s/mm2时病灶显示最佳。DWI联合DCE-MRI检出并诊断DN结节15个(占83.3%)、SHCC病灶19个(占95.0%)。结论 b值600 s/mm2时对DN和SHCC�Objective To study the feasibility and application value of multiple b value DWI combined with DCE-MRI in the differential diagnosis of Hepatic cirrhosis dysplasia nodules and small liver cancer thus providing reference for the prevention and early diagnosis of liver cancer.Methods17cases with hepatic dysplasia nodules(18lesions)and18cases with small liver cancer(20lesions)proved by the pathology for MRI examination in our hospital from March2012to September2017were convenient selected,and all patients underwent the routine MRI plain scanning,multiple b value DWI combined with DCE-MRI,and the ratio of DN and SHCCC to the background signal intensity of liver parenchyma was analyzed by the imaging results,and the ROC carve was used to analyze the best parameter of lesions shown by B value.Results18DN and the same phase T1Wl had10high or slightly high signals,7iso-signals,1low signals;fat pressed T2Wl had the12low or slightly low signals(accounting for65.0%),5iso-signals and1high signals;DWI had7iso-signals,1high signals,10low or slightly low signals(accounting for57.7%);Through the dynamically enhanced scanning,1arterial phase was obviously reinforced,while the enhancement degree in the portal vein period and balance period were reduced,showing the relatively high signals.17arterial phases had9relatively high signals,8iso-signals,and in the vein periods,there were11iso-signals,6slightly low signals,while in the balance period,there were4iso-signals,13slightly low signals(accounting for73.0%).12one(accounting for65.0%)had the reinforced focus fibrous septum and latticed in the balance period.With the change of b value from100s/mm^2to800s/mm^2,the intensity of image signal and the signal-to-noise ratio were gradually reduced,and the DN nodules showed a slightly lower signal,and the lesion showed the best when the b value was600s/mm^2in DWI in combination with DCE.For20HCCs,the same T1Wl had12low or slightly low signals,6iso-signals,2high signals and2decreased inverse phase signals.Fat pressed T2Wl had14slightly high

关 键 词：多b值DWI 异型增生结节 小肝癌 磁共振动态增强 肝硬化 

分 类 号：R445.2[医药卫生—影像医学与核医学]