磁共振弥散峰度成像在鉴别肝细胞癌与其他良性结节中的价值  

Eiffcacy of diffusion kurtosis MR imaging for distinguishing hepatocellular carcinoma from benign hepatic nodules

作　　者：黄泽弟 王猛[2] 沈冰奇[2] 李思聪 Huang Zedi;Wang Meng;Shen Bingqi

机构地区：[1]深圳市宝安区中心医院(深圳大学附属第五医院)放射科,518102 [2]中山大学附属第一医院放射诊断科,广州510080

出　　处：《中华普通外科学文献（电子版）》2020年第3期189-194,共6页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的研究磁共振弥散峰度成像(DKI)在鉴别肝细胞癌(HCC)与其他肝脏良性结节中的价值。方法回顾性收集中山大学附属第一医院收治的112例肝脏原发肿瘤患者的临床资料,共计150个肝脏结节,根据病理结果分为良性结节组(56个,包括局灶性结节增生 26个、血管瘤24个、肝腺瘤6个)和HCC组(HCC 94个)。所有患者均行DKI(b=0、50、200、400、800、2 000 s/mm^2)成像,计算不同模型参数值:扩散率(D)、峰度(K)和单指数模型表观扩散系数(ADC)。采用Logistic回归和受试者工作特征(ROC)曲线来比较各参数鉴别HCC与其他肝脏良性结节的诊断效能。结果 HCC组ADC、D、K值中位数(四分位数间距)分别为1.172(0.389) ×10^-3 mm^2/s、1.751(0.759)×10^-3 mm^2/s、0.013(0.315),良性结节组分别为1.670(0.675)×10^-3 mm^2/s、2.510(1.186)×10^-3 mm^2/s、0.162(0.223),两组间差异均有统计学意义(均P<0.001)。ADC、D、K值鉴别HCC与其他肝脏良性结节的曲线下面积分别为0.815、0.779和0.722,截断值分别为1.238×10^-3 mm^2/s、1.881×10^-3 mm^2/s和0.056,敏感度、特异度及准确性分别为87.5%、59.6%、76.7%(ADC),83.9%、62.8%、76.0%(D)和75.0%、60.6%、70.0%(K)。结论 DKI参数值D、K及常规扩散加权成像参数值ADC均可以用于鉴别HCC与局灶性结节增生、血管瘤及肝细胞腺瘤,ADC值的敏感度、特异度及准确性高于D、K值。Objective To assess the value of diffusion kurtosis imaging (DKI) in distinguishing hepatocellular carcinoma (HCC) from other benign hepatic nodules.Methods According to the pathological results,150 hepatic nodules of 112 patients from the First Affiliated Hospital of Sun Yat-sen University were divided into two groups:benign group (26 of focal nodular hyperplasia,24 of hemangioma,6 of hepatocellular adenoma) and malignant group (94 of HCC).Preoperative MRI examinations including DKI (b values:0,50,200,400,800 and 2 000 s/mm^2) were performed.Apparent diffusion coefficient (ADC) and DKI-derived parameters such as diffusivity values (D),kurtosis values (K) were analyzed by Logistic regression and receiver operating characteristic (ROC) curve to evaluate their efficacy for distinguishing HCC from benign hepatic nodules.Results The median (interquartile range) values of ADC,D and K of malignant group were 1.172(0.389)×10^-3 mm^2/s,1.751(0.759)×10^-3 mm^2/s,and 0.013(0.315),while those of benign group were 1.670(0.675)×10^-3 mm^2/s,2.510(1.186)×10^-3 mm^2/s and 0.162(0.223),respectively.There were statistically significant differences in ADC,D and K between the two groups(all P<0.001).The area under the curve of ADC,D,and K to identify HCC and liver benign nodules were 0.815,0.779,and 0.722,and the optimal cut-off values were 1.238×10^-3 mm^2/s,1.881×10^-3 mm^2/s,0.056,the sensitivity,specificity and accuracy were 87.5%,59.6%,76.7% (ADC);83.9%,62.8%,76.0% (D);75.0%,60.6%,70.0% (K),respectively.Conclusions DKI parameter values D,K and conventional DWI parameter value ADC can be used to distinguish HCC from focal nodular hyperplasia,hemangioma and hepatocellular adenoma.The sensitivity,specificity and accuracy of ADC are higher than D and K.

关 键 词：局限性结节状增生 肝肿瘤 磁共振成像 弥散 表观弥散散系数 D值 K值 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]