MR弥散加权成像在延迟期强化的肝脏恶性肿瘤与肝血管瘤鉴别诊断中的应用

白若冰; 郭启勇; 石喻; 卢再鸣; 杨京川; 孙宝海

中国临床医学影像杂志 ›› 2011, Vol. 22 ›› Issue (5) : 316-320.

论著

MR弥散加权成像在延迟期强化的肝脏恶性肿瘤与肝血管瘤鉴别诊断中的应用

白若冰1，郭启勇1，石喻1，卢再鸣1，杨京川2，孙宝海1

作者信息 +

Potential of diffusion-weighted MR in differentiating primary malignant liver tumorenhanced in delayed phase and cavernous hemangioma

BAI Ruo-bing1, GUO Qi-yong1, SHI Yu1, LU Zai-ming1, YANG Jing-chuan2, SUN Bao-hai1

Author information +

文章历史 +

摘要

目的：探讨MR弥散加权成像（DWI）在延迟期明显强化的肝脏恶性肿瘤和肝血管瘤鉴别诊断中的应用价值。方法：本研究收集2009年7月~2010年1月在我院就诊的肝脏占位性病变，且病变延迟期强化的病例共32例。其中包括肝细胞癌9例，胆管细胞癌12例，肝血管瘤11例。延迟期强化病灶定义为肝脏多期动态增强扫描显示病灶延迟期强化程度高于动脉期。如果病灶较大且血供明显不均匀，则按照上述条件将同一病灶内的延迟强化区纳入研究范围。对所有病灶进行b=500s/mm2的DWI扫描，DWI扫描所得图像由两名高年资放射科医师（执业年龄大于5年）背靠背评价，主要评价在b=500s/mm2图像上肝脏占位性病变信号的高低。利用后处理得到的表观弥散系数（ADC）图划定感兴趣区进行ADC值测量。采用SPSS16.0软件包对图像分析及处理所得到的计量及计数数据进行处理。对不同肝脏占位性病变b=500s/mm2时的图像信号高低的评价结果进行χ2检验，以P<0.05作为有显著性差异。所有病灶的ADC值用均数±标准差表示，肝细胞癌、胆管细胞癌及肝血管瘤病例的ADC值之间两两进行均数比较t检验进行分析，以P<0.05为具有统计学意义。结果：本实验所研究的这3种肝脏占位性病变当b=500s/mm2图像信号高低没有显著性差异（χ2=1.30，P>0.05）。肝细胞癌病例ADC值[（1.28±0.46）mm2/s]和胆管细胞癌病例ADC值[（1.61±0.38）mm2/s]均显著低于肝血管瘤患者[（2.85±0.89）mm2/s]（t=4.780，P=0.000；t=3.7025，P=0.001）。而肝细胞癌病例与胆管细胞癌病例的ADC值没有显著性差异（t=1.8008，P=0.088）。结论：MR DWI在延迟期强化肝脏恶性肿瘤与肝血管瘤鉴别诊断中有较高的应用价值，可以作为常规序列的有益补充。

Abstract

Objective: To investigate the potential of diffusion-weighted MR imaging(DWI) in differentiating primary malignant liver tumor enhanced in delayed phase on contrast-enhanced MRI and cavernous hemangioma. Materials and Methods: Diffusion weighted MR scans were performed using an 1.5T MR scanner at a b value of 500s/mm2 in 32 cases of focal hepatic lesions enhanced in delayed phase on contrast-enhanced MRI, including 11 cavernous hemangiomas and 21 primary malignant tumors(9 hepatocellular carcinomas, 12 cholangiocarcinomas). Quantitative analysis was performed using the regions of interest(ROI) settled on these tumors. The mean ADC values of cavernous hemangioma, hepatocellular carcinoma and cholangiocarcinoma were calculated and analyzed by student t tests respectively. P value of less than 0.05 was considered to indicate statistical significance. Results: The mean ADC value of hepatocellular carcinoma[(1.28±0.46)×10-3] and cholangiocarcinoma[(1.61±0.38)×10-3] were significantly lower than that of cavernous hemangioma[(2.85±0.89)×10-3](t=4.780, P=0.000; t=3.7025, P=0.001 respectively). However, there were no significant differences of mean ADC values between hepatocellular carcinoma and cholangiocarcinoma(t=1.8008, P=0.088). Conclusion: DWI might be helpful to differentiate primary malignant liver tumor enhanced in delayed phase on contrast-enhanced MRI from cavernous hemangioma.

导出引用

白若冰;郭启勇;石喻;卢再鸣;杨京川;孙宝海. MR弥散加权成像在延迟期强化的肝脏恶性肿瘤与肝血管瘤鉴别诊断中的应用[J]. 中国临床医学影像杂志. 2011, 22(5): 316-320

BAI Ruo-bing;GUO Qi-yong;SHI Yu;LU Zai-ming;YANG Jing-chuan;SUN Bao-hai. Potential of diffusion-weighted MR in differentiating primary malignant liver tumorenhanced in delayed phase and cavernous hemangioma[J]. Journal of China Clinic Medical Imaging. 2011, 22(5): 316-320

中图分类号： Ｒ735.7 Ｒ445.2