DWI在肝脏恶性肿瘤微血管侵犯中的诊断价值及其意义探讨  

The Value of DWI in the Diagnosis of Micro-vascular Invasion of Liver Malignant Tumor and Exploration of its Significance

作　　者：刘旋辉[1] 毛志群[2] 罗晓[1] LIU Xuan-hui;MAO Zhi-qun;LUO Xiao(Department of Radiology,The Second People'Hospital of Hunan Province,Changsha 410007,Hunan Province,China)

机构地区：[1]湖南省第二人民医院放射科,湖南长沙410007 [2]湖南省人民医院放射科,湖南长沙410007

出　　处：《中国CT和MRI杂志》2020年第10期80-83,共4页Chinese Journal of CT and MRI

摘　　要：目的探讨磁共振弥散加权成像(DWI)对于肝脏恶性肿瘤微血管侵犯(MVI)中的诊断价值。方法回顾性分析2014~2017年在我院普外科确诊的60例肝细胞癌(HCC)患者的临床和影像学资料。按照术前DWI的肿瘤信号强度(SI)分为均匀SI和强SI,定量测定SI和表面弥散系数(ADC),并进行Logistic回归分析MVI的独立预测因子。分析HCC病灶组织学分级与ADC、SI的相关性。结果单因素回归分析结果显示,组织学3级、肿瘤体积大、高SI、低ADC与MVI显著相关。多因素回归分析结果显示,组织学3级和低ADC是MVI的独立预测因子。ADC在1.11×10-3mm2/sec的诊断界值(cutoff值)时,诊断MVI敏感性93.5%,特异性72.2%;与不存在MVI的HCC组织学2级病灶相比较,存在MVI的HCC组织学2级病灶的ADC明显降低(P<0.05);对于组织学3级病灶而言,存在MVI的HCC病灶的ADC有降低的趋势。此外,与不存在MVI的HCC组织学2级和3级病灶相比较,存在MVI的HCC病灶SI比值有增加的趋势。结论 DWI诊断MVI中具有重要作用,组织学3级和低ADC(<1.11×10-3mm2/sec)均是HCC术后MVI的预测因子,且HCC病灶组织学分级与ADC、SI均有紧密关联,可借助DWI参数评估组织学分级。Objective To investigate the value of magnetic resonance diffusion weighted imaging(DWI)in the diagnosis of micro-vascular invasion(MVI)in liver cancer,and to explore its significance.Methods The clinical and imaging data of 60 patients with hepatocellular carcinoma(HCC)diagnosed by general surgery in our hospital from 2014 to 2017 were retrospectively analyzed.The SI and the surface diffusion coefficient(ADC)were quantitatively determined according to the SI,SI signal intensity(SI).In addition,this study also conducted a logistic regression analysis of independent predictors of MVI.The correlations between histological grading of HCC lesions and ADC and SI were analyzed.Results Univariate regression analysis showed that histological grade 3,tumor volume,high SI and low ADC were significantly correlated with MVI.Multivariate regression analysis showed that histological grade 3 and low ADC were independent predictors of MVI.ADC at diagnosis of 1.11×10-3mm2/sec cutoff value(cutoff value),the diagnosis of MVI sensitivity of 93.5%,specificity of 72.2%.Compared with HCC grade 2 lesions without MVI,the ADC of HCC grade 2 lesions with MVI was significantly lower(P<0.05).For histologic grade 3 lesions,there is a tendency to decrease ADC in the presence of MVI HCC lesions.In addition,the SI ratio of HCC lesions with MVI tended to increase compared with those without MVI in histological grade 2 and 3 lesions.Conclusion DWI plays an important role in the diagnosis of MVI.Histological grade 3 and low ADC(<1.11×10-3mm2/sec)are the prediction factors of MVI after HCC.The histological grading of HCC lesions is closely related to ADC and SI,and the histological grading can be evaluated by DWI parameters.

关 键 词：磁共振成像 DWI 肝细胞癌 微血管侵犯 

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]