磁共振弥散加权成像及增强扫描对肝脏占位性病变的诊断价值

MR diffusion-weighted imaging and enhanced scan for the diagnosis of liver occupying mass

目的探讨磁共振弥散加权成像(MR DWI)结合增强扫描对肝脏占位性病变的诊断价值。方法回顾性研究56例肝脏占位性病变的MR DWI及增强表现,所有病变均经临床追踪或手术病理证实,包括肝细胞癌11例、胆管细胞癌8例,转移瘤9例、海绵状血管瘤13例、肝囊肿15例。结果肝细胞肝癌典型强化方式为快进快出,胆管细胞癌多为门脉期及延迟期轻度强化,转移瘤多呈环形强化,海绵状血管瘤多呈逐渐强化,少数较小病灶为动脉期强化,并持续至延迟期,肝囊肿无明显强化。在MR DWI上肝细胞肝癌、胆管细胞癌、转移瘤多为稍高信号,海绵状血管瘤为明显高信号,肝囊肿呈低信号。肝细胞肝癌、胆管细胞癌、转移瘤弥散系数(ADC)值差异无统计学意义(P>0.05),但明显低于血管瘤与肝囊肿囊内ADC值(P<0.05),肝囊肿ADC值明显高于其他各组(P<0.05)。结论 MRDWI在肝脏良恶性病变鉴别诊断中具有重要作用,结合增强扫描可提高诊断准确率。

Objective To evaluate the value of MR diffusion-weighted imaging and enhanced scan in the diagnosis of liver occupying mass. Methods Retrospective study was conducted to 56 patients with liver space occupying lesions including hepatocellular carcinomas （n = 11 ）, cholangiocellular carcinoma（n = 8）, metastasis （n = 9）, hemoangiomas （n = 13）and hepatic cysts （n = 15） proven surgically and clinically underwent MR diffusion-weighted imaging and enhanced scan. Results Typical enhancement pattern of hepatocellular carcinoma rapidly increased and decreased. Cholangiocellular carcinoma mostly enhanced in venous phase and delayed phase, metastasis was wall enhancement, hemoangiomas mostly gradually strengthened, hepatic cysts without enhancement. In hepatocellular carcinomas, cholangiocellular carcinoma and metastasis, main signal intensities were high in DWI, hemoangiomas showed high signal, and hepatic cysts showed low signal. Hepatocellular carcinomas, cholangiocellular carcinoma and metastasis had no significant difference in ADC （P〈0. 05）. Hepatic cysts were significantly higher than other groups （P〈0.05）. Conclusion Enhanced MR scans has an important role in the diagnosis of liver occupying mass. Combined with DWI, the accuracy of diagnosis can be improved.