多模态MRI对肝硬化再生结节良恶性评估价值研究  

The Value of Multimodal MRI in the Evaluation of Benign and Malignant Regenerative Nodules in Liver Cirrhosis

作　　者：聂林[1] 刘琼 黎海珠 何松[1] 曾洋 王志强[2] NIE Lin;LIU Qiong;LI Hai-zhu;HE Song;ZENG Yang;WANG Zhi-qiang(Department of Radiology,the Affiliated Hospital of Xiangnan University,Chenzhou 423000,Hunan Province,China;Xiangnan University,Chenzhou 423000,Hunan Province,China)

机构地区：[1]湘南学院附属医院放射科,湖南郴州423000 [2]湘南学院,湖南郴州423000

出　　处：《中国CT和MRI杂志》2025年第3期123-126,共4页Chinese Journal of CT and MRI

基　　金：湖南省卫生健康委2023年度卫生科研课题资助项目(D202309018340);医学影像人工智能湖南省重点实验室资助(湘科计〔2020〕60号,2020TP1021)。

摘　　要：目的探讨多模态MRI对肝硬化再生结节良恶性鉴别诊断的价值,提高早期小肝细胞癌诊断水平。方法回顾性分析我院2019年1月至2023年10月收治的肝硬化伴再生结节患者100例影像资料,结果均以病理活检为“金标准”。所有患者均为多模态磁共振成像,包括常规MRI平扫,功能磁共振弥散成像(diffusion weighted imaging,DWI)、钆塞酸二钠(GD-EOB-DTPA)动态增强扫描及肝胆特异期成像等,比较肝硬化再生结节良恶性在多模态MRI上信号特征、弥散程度、肝胆特异期GD-EOB-DTPA摄取情况等方面的差别。结果在100例患者中,经多模态MRI成像共发现120个病灶,根据病理活检分为再生结节(RN)组和小肝癌(sHCC)组;其中病理诊断RN组共80个病灶(66.7%),sHCC组共40个病灶(33.3%);对照病理结果,多模态MRI对肝硬化再生结节良恶性判断的灵敏度、特异度、准确度分别为92.86%、88.89%、91.67%,均高于其他单独MRI检查方法(P<0.05);肝硬化恶性再生结节的ADC值明显低于良性再生结节(P<0.05);肝硬化良性再生结节中有75个病灶可见明显摄取GD-EOB-DTPA,占93.75%,而恶性再生结节中仅5个病灶少量摄取GDEOB-DTPA,占12.5%(P<0.05)。结论多模态磁共振成像对肝硬化再生结节良恶性的评估具有较高的诊断效能,可为临床早期精准诊治提供依据。Objective To explore the value of multimodal MRI for benign and malignant differential diagnosis of regenerative nodules in liver cirrhosis,and to improve the diagnosis of early small hepatocellular carcinoma.Methods The imaging data of 100 patients with cirrhosis with regenerative nodules admitted to our hospital from January 2019 to October 2023 were retrospectively analyzed,and the results were all based on pathological biopsy as the gold standard.All patients had multimodal magnetic resonance imaging,including conventional MRI plain scanning,functional magnetic resonance diffusion weighted(DWI)imaging,gadoxetic acid disodium(GD-EOB-DTPA)dynamic enhancement scanning,and hepatobiliary-specific phase imaging,etc.,to compare the benign and malignant cirrhosis with regenerative nodules on multimodal MRI in terms of the signal characteristics,the degree of diffusion and differences in GD-EOB-DTPA uptake in hepatobiliary-specific phase.Results In 100 patients,a total of 120 lesions were detected by multimodal MRI imaging,which were divided into regenerative nodule(RN)group and small hepatocellular carcinoma(sHCC)group according to pathological biopsy;among them,a total of 80 lesions were diagnosed by pathology in the RN group(66.7%),and a total of 40 lesions were diagnosed by pathology in the sHCC group(33.3%);in comparison with the pathological results,the sensitivity,specificity,and accuracy of the judgment of benignness and malignancy of regenerative nodules of cirrhosis by multimodal MRI were as follows sensitivity,specificity,and accuracy were 92.86%,88.89%,and 91.67%,respectively,which were higher than those of other individual MRI examination methods(P<0.05);the ADC values of malignant regenerative nodules in cirrhosis were significantly lower than those of benign regenerative nodules(P<0.05);75 lesions in benign regenerative nodules in cirrhosis were seen to be significantly uptake of GD-EOB-DTPA,accounting for 93.75%,while only 5 lesions in malignant regenerative nodules showed a small amount of GD-EOB-DTPA

关 键 词：多模态 磁共振 弥散加权成像 肝胆特异期 肝硬化 再生结节 

分 类 号：R735.7[医药卫生—肿瘤]