DWI在肝硬化癌前病变鉴别诊断中的临床价值

Clinical value of DWI in the the differential diagnosis of precancerous lesion of hepatocirrhosis

目的探讨核磁共振弥散加权成像(DWI)技术ADC值在肝硬化再生结(RN)、癌前病变(DN)、早癌及原发性小肝癌(SHCC)的鉴别诊断中价值。方法采用ADC值测定结合容积采集技术LAVA动态扫描,在228例肝硬化患者中,再生结节性(RN)患者121例,DN结节9例,原发性肝癌98例,其中小肝癌(SHCC)及早期小癌(ESHCC)21例;正常组90例;测定ADC值的演变过程。结果本研究鉴别诊断RN结节、DN结节、HCC的检出率分别为45.15%、3.36%、36.57%,其中SHCC及ESHCC的检出率7.84%。测定RN结节的ADC值为(2.0±0.22)×10-3 mm2/s、DN结节的ADC值为(1.50±0.27)×10-3 mm2/s,演变为SHCC或ESHCC时其ADC值下降为(1.17±0.19)×10-3 mm2/s。结论随着肝硬化-再生结节-癌前结节-肝癌的病理演变过程,其ADC值呈逐渐下降趋势,各组ADC均值存在显著性差异(P<0.05),DWI技术可以对肝硬化各个阶段病变进行较为准确可信的判断。

Objective To discuss the clinical value of ADC number of DWI in the differential diagnosis of precancerous lesion of hepatocirrhosis with regenerative nodules （RN）, precancerous lesions （DN）, early carcinoma, and primary small hepatocellular carcinoma （SHCC）. Methods The detection of ADC number integrating LAVA dynamic scan of volume acquisition technique was adopted to evaluate the ADC number in 228 patients with hepatocirrhosis, in which regenerative nodules （RN） was 121 cases, DN was 9 cases, primary liver cancer was 98 cases including 21 cases of small hepatocellular carcinoma （SHCC） and early small hepatocellular carcinoma （ESHCC）, Normal group consisted of 90 cases. Results The detectable rate of differential diagnosis in this study were mon 45. 15~ for DN nodules, 3. 36~ for RN nodules, and 36.57 % for HCC, among which 7.84 ~ accounted for SHCC and ESHCC. The ADC number for checking RN nodule was （2.0~0.22））〈 10 3 mm2/s and, for DN nodule, was （1.50~0.27） X 10 3 mm2/s. The ADC number decreased to （1.50＋ 0.27） ）〈 10 3 mmz/s, while, evolved into SHCC or ESHCC. Conclusion With evolution of the pathology as followings, i. e. , from hepatocirrhosis to regenerative nodules, to precancerous nodules and to hepatocarcinoma, the ADC number de- creases step by step and all of the group＇s ADC number are significant difference （ P d0.05）. So DWI can be more accu- rate and believable on the judgment all stages of hepatocirrhosis.