DCE-MRI定量参数结合CT动态增强扫描诊断儿童肝脏占位性病变良恶性的研究  

Quantitative parameters of dynamic enhanced magnetic resonance imaging (DCE-MRI) combined with computed tomography (CT) dynamic enhanced scanning in the diagnosis of benign and malignant liver space occupying lesions in children

作　　者：武林[1] 陈萌萌 王爱平[1] WU Lin;CHEN Meng-meng;WANG Ai-ping(Department of Radiology,Children′s Hospital Affiliated to Soochow University,Jiangsu 215000,China)

机构地区：[1]苏州大学附属儿童医院放射科,江苏215000

出　　处：《肝脏》2025年第3期361-365,共5页Chinese Hepatology

基　　金：苏州市科技计划项目(医疗卫生科技创新)(SKY2022012)。

摘　　要：目的分析动态增强磁共振成像(DCE-MRI)定量参数结合CT动态增强扫描诊断儿童肝脏占位性病变良恶性。方法选择2018年7月—2024年5月苏州大学附属儿童医院就诊的肝脏占位性病变患儿的临床资料进行回顾性分析,以病理性检查结果将其分为恶性组(46例)、良性组(153例)。对比2组CT扫描各期特点与DCE-MRI定量参数,以病理学检查为金标准,分析CT动态增强扫描与金标准诊断肝脏占位性病变良恶性的一致性,分析肝脏占位性病变为恶性的相关因素,分析DCE-MRI定量参数结合CT动态增强对肝脏占位性病变为恶性的诊断价值。结果恶性组最大上升斜率(MSI)为92.53±10.87、平均强化时间(MET)508.34±51.45、正性增强积分(PEI)34.57±4.82,低于良性组(分别为265.14±29.76、557.42±58.30、241.30±26.48,P<0.05),恶性组增强曲线下初始面积(IAUC)(36.78±5.63)高于良性组(23.41±4.29)(P<0.05)。恶性组延迟期低增强例数占比(95.65%)、动脉期高增强例数占比(100.00%)高于良性组(分别为0.00%、11.11%)(P<0.05),恶性组门静脉期等增强例数占比(67.39%)低于良性组(96.08%)(P<0.05)。CT动态增强扫描与金标准诊断肝脏占位性病变良恶性的一致性中等(Kappa值=0.735,P<0.05)。MSI(OR=0.234,95%CI:0.103~0.532)、PEI(OR=0.277,95%CI:0.122~0.629)、IAUC(OR=3.823,95%CI:1.681~8.696)为肝脏占位性病变为恶性的相关因素(P<0.05)。MSI、PEI、IAUC、CT动态增强扫描及四者联合诊断肝脏占位性病变为恶性的曲线下面积(AUC)值分别为0.797、0.803、0.845、0.819、0.913(P<0.05),且四者联合的AUC值更高(P<0.05)。结论MSI、PEI、IAUC、CT动态增强扫描在诊断儿童肝脏占位性病变良恶性中具有重要价值,且四者联合的诊断价值更高。Objective To analyze the quantitative parameters of dynamic enhanced magnetic resonance imaging(DCE-MRI) combined with dynamic enhanced computed tomography(CT) scanning in the diagnosis of benign and malignant liver space occupying lesions in children.Methods Clinical data of children with hepatic space occupying lesions who admitted to the Children's Hospital of Soochow University from July 2018 to May 2024 were retrospectively analyzed.They were divided into malignant group(46 cases) and benign group(153 cases) based on pathological examination results.The characteristics of CT scanning and quantitative parameters of DCE-MRI were compared between the two groups.Using the pathological examination as the gold standard,the consistency between CT dynamic enhanced scan and the gold standard in diagnosing benign and malignant liver space occupying lesions,ang the related factors of malignant liver space occupying lesions were analyzed.The diagnostic value of DCE-MRI quantitative parameters combined with CT dynamic enhancement in malignant liver space occupying lesions was analyzed.Results The maximum rise slope(MSI)(92.53±10.87),mean strengthening time(MET)(508.34±51.45) and positive enhancement score(PEI)(34.57±4.82) in the malignant group were lower than those in the benign group [265.14±29.76),557.42±58.30) and 241],respectively.The initial area under enhancement curve(IAUC) in the malignant group(36.78±5.63) was higher than that in the benign group(23.41±4.29)(P<0.05).In the malignant group,the proportion of low enhancement in delayed stage(95.65%) and high enhancement in arterial stage(100.00%) were higher than those in benign group(0.00% and 11.11%,respectively)(P<0.05),and the proportion of equal enhancement in portal vein stage in the malignant group(67.39%) was lower than that in benign group(96.08%)(P<0.05).There was moderate consistency between CT dynamic enhanced scan and gold standard in the diagnosis of benign and malignant hepatic space occupying lesions(Kappa =0.735,P<0.05).MSI(OR=0.234,95%CI:0

关 键 词：动态增强磁共振成像 CT动态增强扫描 儿童 肝脏占位性病变 诊断价值 

分 类 号：R445.2[医药卫生—影像医学与核医学]