多参数磁共振成像联合LI-RADS分级标准对肝硬化再生结节与小肝癌的诊断价值及临床意义  

Diagnostic value and clinical significance of Mp-MRI combined with the LI-RADS grading criteria for regenerated nodules in cirrhosis and small heptocellular carcinoma

作　　者：蔡宁[1] 石惠 李真真[1] 郭君武[1] CAI Ning;SHI Hui;LI Zhenzhen;GUO Junwu(Medical Imaging Department,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州大学第二附属医院医学影像学科,郑州450003

出　　处：《中国医科大学学报》2024年第8期686-691,共6页Journal of China Medical University

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20210431)。

摘　　要：目的探讨多参数磁共振成像(Mp-MRI)联合肝脏影像报告和数据管理系统(LI-RADS)分级标准对肝硬化再生结节与小肝癌(SHCC)的诊断价值及临床意义。方法选取2019年3月至2023年3月我院直径≤3 cm的肝脏结节患者86例(132个结节),根据手术病理结果将肝硬化再生结节38例(54个结节)记为良性组,SHCC 48例(78个结节)记为恶性组。比较2组LI-RADS分级和Mp-MRI参数[增强率(ER)、平均强化时间(MET)、最大上升斜率(MSI)、最大下降斜率(MSD)、表观扩散系数(ADC)、脂肪分数(FF)],分析其诊断价值。结果经LI-RADS分级标准诊断,132个结节中共检出阳性76个,阴性56个,其中假阳性10个,假阴性12个;恶性组ER、MET、MSI、ADC低于良性组,FF、MSD高于良性组(P<0.05);受试者操作特征(ROC)曲线分析结果显示,Mp-MRI参数联合LI-RADS分级标准诊断肝硬化再生结节与SHCC的曲线下面积(AUC)为0.946(95%CI:0.892~0.977),约登指数为0.811,灵敏度为88.46%,特异度为92.59%,优于各Mp-MRI参数及LI-RADS分级单独诊断;恶性组不同病理分级结节LI-RADS分级比较,差异有统计学意义(P<0.05);ER、MET、MSI、ADC在高分化结节中最高,中分化结节次之,低分化结节最低,FF、MSD在低分化结节最高,中分化结节次之,高分化结节最低(P<0.05);Spearman相关性分析结果显示,LI-RADS分级、ER、MET、MSI、ADC与SHCC病理分级呈正相关,FF、MSD与SHCC病理分级呈负相关(P<0.05)。结论Mp-MRI参数联合LI-RADS分级标准诊断肝硬化再生结节与SHCC的价值可靠,且能为临床评估SHCC病理分级提供参考依据。Objective To explore the diagnostic value and clinical significance of multi-parametric magnetic resonance imaging(Mp-MRI)combined with the liver imaging reporting and data system(LI-RADS)grading criteria for diagnosing regenerative nodules and small hepatocellular carcinoma(SHCC)in patients with cirrhosis.Methods Eighty-six patients(132 nodules)admitted to our hospital from March 2019 to March 2023 with liver nodules of≤3 cm in diameter were selected.Based on the surgical pathology results,38 cases(54 nodules)of regenerative nodules in liver cirrhosis were classified into the benign group,and 48 cases(78 nodules)of SHCC were classi-fied into the malignant group.LI-RADS classification and Mp-MRI parameters[enhancement rate(ER),mean enhancement time(MET),maximum slope of increase(MSI),maximum slope of decrease(MSD),apparent diffusion coefficient(ADC),and fat fraction(FF)]were compared between the two groups,and their diagnostic values were analyzed.Results Based on the LI-RADS classification standard,76 positive and 56 negative nodules were detected among the 132 nodules,including ten false positives and 12 false negatives.The ER,MET,MSI,and ADC were lower in the malignant group than in the benign group,whereas the FF and MSD were higher in the malignant group than in the benign group(P<0.05).The area under the receiver operating characteristic(ROC)curve for the combined diagnosis of liver cirrhosis regenerative nodules and SHCC using Mp-MRI parameters and the LI-RADS classification standard was 0.946(95%CI:0.892-0.977),with a Youden index of 0.811,sensitivity of 88.46%,and specificity of 92.59%.These results were superior compared to the diagnosis using each Mp-MRI parameter and the LI-RADS classification standard alone.A significant difference in the LI-RADS clas-sification of nodules of different pathological grades was observed in the malignant group(P<0.05).The ER,MET,MSI,and ADC were highest in well-differentiated nodules,followed by moderately differentiated nodules,and were lowest in poorly differentiate

关 键 词：肝硬化再生结节 小肝癌 多参数磁共振成像 肝脏影像报告和数据管理系统分级标准 诊断价值 

分 类 号：R445.2[医药卫生—影像医学与核医学]