CT增强扫描与磁共振检查诊断肝血管瘤和肝细胞癌价值分析  

Is the magnetic resonance imaging superior to CT scan in the differential diagnosis of hepatic hemangioma and hepatocellular carcinoma?

作　　者：魏野 汪施妤 葛高华[1] 井桂银[1] Wei Ye;Wang Shiyu;Ge Gaohua(Department of Radiology,First People's 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市第一人民医院影像中心,江苏省淮安市223300

出　　处：《实用肝脏病杂志》2024年第2期279-282,共4页Journal of Practical Hepatology

基　　金：江苏省科技厅社会发展重点研究计划项目(编号:BE2019638)。

摘　　要：目的研究CT与磁共振(MRI)增强扫描诊断肝血管瘤(HH)和肝细胞癌(HCC)的价值。方法2020年6月~2022年6月淮安市第一人民医院诊治的HH患者32例和HCC患者37例,常规接受CT和MRI增强扫描,经手术或穿刺取得肝组织,行病理学检查。采用Kappa检验评定诊断方法之间的一致性,应用MedCalc15.1统计学软件绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估诊断效能。结果以病理学检查为诊断的金标准,CT增强扫描发现29例(78.4%)HCC和24例(75.0%)HH,而MRI扫描发现35例(94.6%)HCC和29例(90.6%)HH;经Kappa一致性检验,CT和MRI扫描与病理学诊断HH和HCC具有一致性(Kappa=0.532,P<0.05和Kappa=0.749,P<0.05);MRI扫描诊断肝内占位性的灵敏度、特异度和准确性分别94.6%、90.6%和92.8%,显著优于CT诊断(分别为78.4%、75.0%和76.8%),而两者联合诊断并不能显著提高诊断效能(分别为90.6%、90.6%和92.8%)。结论临床在鉴别原发性肝癌与HH困难时,应首先进行MRI检查。Objective The aim of this study was to compare the diagnostic efficacy of CT and magnetic resonance imaging(MRI)in the differential diagnosis of patients with hepatic hemangioma(HH)and hepatocellular carcinoma(HCC).Methods 69 patients with intrahepatic space-occupying lesions were encountered in Huai'an First People's Hospital between June 2020 and June 2022,all patients received enhanced CT and MRI scanning,and underwent liver biopsies or hepatectomy.The Kappa test was used to analyze the agreement between CT and MRI diagnosis based on histopathological diagnosis.The area under the receiver operating characteristic curve(AUC)was applied to determine the diagnostic efficacy.Results Based on histopathological examination,the CT scan found primary liver cancer(PLC)in 29 cases(78.4%)and HH in 24 cases(75.0%),while the MRI diagnose correctly PLC in 35 cases(94.6%)and HH in 29 cases;the enhanced CT and MRI scan were consistent with the pathological diagnosis as respect to the diagnosis of HH and HCC by Kappa test(Kappa=0.532,P<0.05 and Kappa=0.749,P<0.05);the sensitivity(Se),the specificity(Sp)and the accuracy by MRI scan in diagnosing the intrahepatic occupying lesions were 94.6%,90.6%and 92.8%,much superior to 78.4%,75.0%and 76.8%by CT scan,while the combination of the two didn’t improve the diagnostic efficacy(90.6%,90.6%and 92.8%,respectively).Conclusion The optimal check-up might be the MRI scan in determining the quality of intrahepatic occupying lesions.

关 键 词：肝细胞癌 肝血管瘤 CT扫描 磁共振成像 诊断 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44