磁共振R_2~*及T_2~*技术评估肝脏常见占位性病变的血氧水平及其临床意义

Clinical value of blood oxygen level evaluated with noninvasive magnetic resonance multi-echo R_2~* technique in diagnosis of the benign and malignant masses in liver

目的：探讨MRI血氧水平参数R2＊、T2＊值在肝脏常见占位性病变之间的差异及其鉴别诊断价值。方法：分别对一组肝细胞癌、肝内胆管细胞癌、转移瘤、血管瘤及肝脓肿病例行MRI多回波R2＊扫描。在R2＊图和T2＊图上分别测量病灶、脾及脊柱旁骨骼肌的T。’值和＆。值，同时计算病灶／脾及病灶／肌比值。分析以上参数在以上不同病种之间的差异。结果：在5种肝脏占位性病变中，海绵状血管瘤的R2＊“值及其比值最小、T2＊’值及其比值则最大。血管瘤的T。”病灶／肌比值明显大于肝脓肿及肝转移瘤（P〈O．05）。肝细胞癌的R2＊值、R2＊病灶／肌比值明显大于血管瘤，而Tz”病灶／肌比值则小于血管瘤（P〈0．05）。另外，肝细胞癌的R2＊病灶／脾比值也明显大于肝脓肿（P=0．044，t=2．222）。在肝细胞癌、胆管细胞癌及转移瘤3种恶性肿瘤之间，胆管癌分别与血管瘤、肝脓肿之间，转移瘤与肝脓肿之间R2＊、T2＊值及其比值差异均无统计学意义（P〉O．05）。结论：MRI血氧水平参数有助于血管瘤与肝细胞癌、转移瘤及肝脓肿之间，肝脓肿与肝细胞癌之间的鉴别，但对不同恶性肿瘤、对胆管癌与其他疾病之间的鉴别存在一定困难。

Objective： To probe the differences in the blood oxygen level parameters, R2＊and T2＊ values among hepatic masses and there clinical value in differential diagnosis. Methods.. Multi-echo R2 ＊sequence was carried out on a group of hepatic masses including hepatoeellular carcinoma （ HCC）, intrahepatic cholangiocareinoma, liver metastasis, cavernous hemangioma and hepatic abscess. The ＂T＂2 ＊ and R2＊values of spleen and paraspinous muscle on T2＊and R2＊ map,and the ratios of lesion to spleen （L/S） and muscle （L/ M） were calculated respectively. The differences in T2＊, R2＊ values and relative parameters among HCC, different lesions above were analyzed. Results： The R2 ＊ value and its ratios of cavernous hemangioma were the smallest among 5 hepatic masses,whereas the T2＊ value and its ratios were reverse. The T2＊ ratio of L/M of hemangioma was larger than abscess and metastasis statistically（P〈0.05）. The R2＊value and its ratio of L/M of HCC was larger than hemangioma,while the Te ＂ ratio of L/M was reverse （P〈O. 05）. The R2＊ ratio of L/S of HCC was also larger than abscess（P= 0. 044, t = 2. 222）. ＂No difference in all MR measured parameters was found between three malignant masses, between cholangiocarcinoma and hemangioma or abscess, and between metastasis and abscess statisti- cally （P〉0. 05）. Condttsion： The blood oxygen level parameters may help to differentiate the hemangioma with HCC,metastasis and abscess,and to differentiate HCC and metastasis. However, it is difficult to identify the different malignant lesions, and to identify eholangiocarcinoma from other lesions.