DCE-MRI鉴别肝脏占位性病变的研究

DCE-MRI in differential diagnosis of liver lesions

目的:研究DCE-MRI定量参数在肝脏占位性病变中的诊断价值。方法:采用MRI扫描仪对55例肝脏占位患者进行定量动态增强扫描,分别测量定量血流动力学参数:容量转运常数(Ktrans)、血管外细胞外容积分数(Ve)和速率常数(Kep),血管瘤组、肝癌组及转移瘤组间定量参数行单因素方差分析及LSD法两两比较;对3组组间绘制受试者特性(ROC)曲线。结果:血管瘤与肝癌、血管瘤与转移瘤、肝癌与转移瘤组之间Ktrans及Ve值差异均有统计学意义(P<0.05);血管瘤与肝癌、肝癌与转移瘤组间Kep值差异有统计学意义(P<0.05);血管瘤与转移瘤组间Kep差异无统计学意义(P>0.05)。以最大约登指数得到最佳诊断切点值,则3者判断及鉴别血管瘤和肝癌的敏感度分别为88.2%、82.4%、94.1%,特异度分别为81.8%、59.1%、81.8%;鉴别血管瘤与转移瘤的敏感度分别为68.2%、68.2%、50.0%,特异度分别为81.2%、87.5%、81.2%;鉴别肝癌与转移瘤的敏感度分别为100.0%、82.4%、100.0%,特异度分别为93.7%、93.7%、93.7%。结论:DCE-MRI定量血流动力学参数Ktrans、Kep对肝脏占位性病变的鉴别诊断具有很高的价值。

Objective： To evaluate the value of quantitative parameters of DCE-MRI in the diagnosis of liver lesions.Methods： Fifty-five patients of liver tumors underwent MRI examination. MR scanner was used to obtain the quantitative MR pharmacokinetic parameters： Ktrans（volume transfer constant）, Kep（exchange rate constant） and Ve（extravascular extracellular volume fraction）. The mean Ktrans, Kep and Ve of liver cancer, liver hemangioma and liver metastasis were calculated and compared with each other using LSD method. Receiver operating characteristic curve（ROC） analysis was used for comparing the difference between liver cancer and liver hemangioma. Results： There were significant differences in Ktransand Ve（P0.05） between liver cancer and liver hemangioma, liver hemangioma and liver metastasis, liver cancer and liver metastasis, and also in Kep（P0.05） between liver hemangioma and liver cancer, liver cancer and liver metastasis. There was no significant difference between liver hemangioma and liver metastasis in Kep（P0.05）. The sensitivity of Ktrans, Ve, and Kep were 88.2%, 82.4% and94.1% respectively, and the specificity of Ktrans, Ve and Kep were 81.8%, 59.1% and 81.8% respectively for the differential diagnosis of liver cancer and liver hemangioma. The sensitivity of Ktrans, Ve and Kep were 68.2%, 68.2% and 50.0% respectively, and the specificity of Ktrans, Ve and Kep were 81.2%, 87.5% and 81.2% respectively for the differential diagnosis of liver hemangioma and liver metastasis. The sensitivity of Ktrans, Ve and Kep were 100.0%, 82.4% and 100.0% respectively, and the specificity of Ktrans, Ve, and Kep were 93.7%, 93.7% and 93.7% respectively for the differential diagnosis of liver hemangioma and liver metastasis, with the maximum Youden＇s index as cut-off. Conclusion： The differential diagnosis of liver lesions by Ktrans, Kep derived from DCE-MRI is valuable.