B值800s/mm^2磁共振弥散加权成像(DWI)在肝脏占位性病变鉴别诊断中的应用

Applications of Diffusion-Weighted Imaging(DWI)with B-value as 800s/mm^2 to Differential Diagnosis of Hepatic Occupying Lesions

目的评价b值800s/mm2扩散加权成像(DWI)在肝脏占位性病变鉴别诊断中的应用价值。方法回顾性分析90例肝占位性病变者(肝囊肿14例,肝血管瘤18例,局灶性结节性增生(FNH)6例,肝细胞癌35例,肝转移瘤11例,胆管细胞癌6例)在常规T2WI、T1WI及动态增强扫描(应用LAVA3D序列)外,加做b值800s/mm2DWI检查,观察肝占位性病变在DWI图像影像特征,测量病变及与病变同一层面正常肝组织表观弥散系数值(ADC值),进行比较分析。结果正常肝组织平均ADC值为(1.39±0.13)×10-3mm2/s。肝囊肿、肝血管瘤、局灶性结节性增生(FNH)、肝细胞癌、肝转移瘤、胆管细胞癌平均ADC值分别为(2.47±0.25)×10-3mm2/s、(1.63±0.12)×10-3mm2/s、(1.47±0.07)×10-3mm2/s、(1.07±0.15)×10-3mm2/s、(1.19±0.13)×10-3mm2/s、(1.11±0.08)×10-3mm2/s;恶性肿瘤组、良性肿瘤组正常肝组织与肿瘤组织ADC值之间差异有统计学意义(p<0.01),恶性肿瘤与良性肿瘤ADC值之间差异有统计学意义(p<0.01),局灶性结节性增生(FNH)与正常肝组织ADC值之间差异p=0.923,无统计学差异。结论 MRI、DWI在肝脏占位性病变中有不同特点,综合量化分析病灶ADC值与正常肝组织ADC值,能更好地显示肝脏占位性病变特征,在鉴别诊断及临床治疗、预后方面提供重要参考价值。

Objective To access the value of diffusion-weighted imaging（DWI）with b-value as 800 s/mm2 in the diagnosis of hepatic focal masses.Methods A total of 90 patients with hepatic occupying lesions including 14 hepatic cyst,18 hepatic hemangioma,6 focal nodular hyperplasia,35 hepatocellular carcinoma,11 hepatic metastatic tumors and 6 cholangiocellular carcinoma were retrospectively analyzed.Beside routine T1WI,T2WI and dynamic enhancment scanning（by LAVA 3D sequence）,the 90 patients have DWI（b-value as 800s/mm2）examination.To observe image characteristics of DWI of hepatic occupying lesions.To measure,contrast and analyze apparent dispersion coefficient（ADC）values of pathological changed hepatic tissue and normal hepatic tissue in the same slice.Result The average ADC value of normal hepatic tissue was（1.39±0.13）×10-3mm2/s.The average ADC values of hepatic cyst,hepatic hemangioma,focal nodular hyperplasia,hepatocellular carcinoma,hepatic metastatic tumors and cholangiocellular carcinoma were（2.47±0.25）×10-3mm2/s,（1.63±0.12）×10-3mm2/s,（1.47±0.07）×10-3mm2/s,（1.07±0.15）×10-3mm2/s,（1.19±0.13）×10-3mm2/s and（1.11±0.08）×10-3mm2/s respectively.Difference in ADC values among malignant tumor,benign tumor and normal hepatic tissue was of statistical significance（p0.01）.However,ADC values of FNH and normal hepatic tissue were not have statistical difference（p=0.923）.Conclusion Different kinds of hepatic occupying lesions demonstrated characteristic features in MRI DWI.By comprehensive and quantitative analyzing of ADC values of normal hepatic tissue and focus,characteristics of hepatic occupying lesions could be showed preferably.It might provide referential importance for the differential diagnosis,clinic therapy and prognosis of hepatic diseases.