多模态MRI对肝硬化增生性结节与小肝癌的鉴别诊断价值探讨  

Diagnostic performance of multimodal MRI in differentiating dysplastic nodules and small hepatocellular carcinoma in patients with liver cirrhosis

作　　者：施莹 柏根基[1] 孙阳 Shi Ying;Bai Genji;Sun Yang(Department of Radiology,First Hospital Affiliated to Nanjing Medical University,Huai'an 223300,Jiangsu Province,China)

机构地区：[1]南京医科大学附属淮安第一医院影像科,江苏省淮安市223300

出　　处：《实用肝脏病杂志》2022年第5期722-725,共4页Journal of Practical Hepatology

基　　金：江苏省医学科学研究基金资助项目(编号:JS20240ES)。

摘　　要：目的探讨应用多模态磁共振成像(MRI)鉴别诊断肝硬化增生性结节(DN)与小肝癌(sHCC)的价值。方法2016年12月~2021年12月我院收治的肝硬化伴肝内结节病变患者71例,以细针穿刺或术后组织病理学检查为金标准诊断。所有患者接受多模态MRI检查,比较动态增强(DCE-MRI)扫描参数,记录纯扩散系数(D值)、伪扩散系数(D*值)和表观扩散系数(ADC)变化。结果在71例患者中,经病理学检查诊断sHCC者45例(63.4%),DN者26例(36.6%);sHCC病灶ADC值、D值和D*值分别为(0.81±0.19)×10^(-3) mm^(2)/s、(0.91±0.21)×10^(-3) mm^(2)/s和(46.26±10.13)×10^(-3) mm^(2)/s,显著小于DN病灶【分别为(1.34±0.33)×10^(-3) mm^(2)/s、(1.22±0.24)×10^(-3) mm^(2)/s和(80.69±13.24)×10^(-3) mm^(2)/s,P<0.05】;经ROC分析显示,D值、D*值和ADC值诊断sHCC的截断点分别为1.14×10^(-3) mm^(2)/s、62.40×10^(-3) mm^(2)/s和0.96×10^(-3) mm^(2)/s,其AUC分别为0.911(95%CI:0.820~0.966)、0.809(95%CI:0.699~0.893)和0.984(95%CI:0.920~0.999)。结论应用多模态MRI检查鉴别诊断DN与sHCC具有较高的效能,可为临床诊治提供极大的帮助。Objective The aim of this study was to explore the diagnostic performance of multimodal magnetic resonance imaging(MRI)in differentiating dysplastic nodules(DN)and small hepatocellular carcinoma(sHCC)in patients with liver cirrhosis(LC).Methods 71 patients with LC with intrahepatic nodules were encountered in our hospital between December 2016 and December 2021,and all underwent multimodal MRI,with the dynamic enhancement(DCE-MRI)parameters,the apparent diffusion coefficient(ADC),pure diffusion coefficient(D)and pseudo diffusion coefficient(D*)recorded.The golden diagnosis was based on fine needle aspiration or post-operational histopathological examination.Results Among the 71 patients,the sHCC was diagnosed in 45 cases(63.4%),and the DN was found in 26 cases(36.6%);the ADC,D and D*in sHCC foci were(0.81±0.19)×10^(-3) mm^(2)/s,(0.91±0.21)×10^(-3) mm^(2)/s and(46.26±10.13)×10^(-3) mm^(2)/s,significantly lower than[(1.34±0.33)×10^(-3) mm^(2)/s,(1.22±0.24)×10^(-3) mm^(2)/s and(80.69±13.24)×10^(-3) mm^(2)/s,respectively,P<0.05]in DN lesions;the ROC analysis showed that when the cut-off values of D,D*and ADC in diagnosing sHCC were set as 1.14×10^(-3) mm^(2)/s,62.40×10^(-3) mm^(2)/s and 0.96×10^(-3) mm^(2)/s,the AUC were 0.911(95%CI:0.820-0.966),0.809(95%CI:0.699-0.893)and 0.984(95%CI:0.920-0.999).Conclusion The multimodal MRI has high diagnostic efficacy in differentiating DN and sHCC in patients with LC,which might provide evidence for appropriate management for the patients.

关 键 词：肝细胞癌 增生性结节 多模态磁共振成像 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R575.2[医药卫生—诊断学] R735.7[医药卫生—临床医学]