HBV相关肝硬化结节演变的多模态MRI研究

A study of multi-modal MRI features on HBV related human multistep hepatocarcinogenesis

目的:通过与病理结果进行对照分析,总结肝硬化再生结节多步演变的多模态MRI影像特征,探讨肝硬化再生结节的早期诊断及鉴别诊断价值。方法:搜集乙肝肝硬化患者50例(85个结节),回顾性分析其MRI平扫及增强扫描资料,对病理证实的多步演变结果与对应的MRI影像表现进行对照研究。结果:MRI检出82个结节,检出率为96.5%,T2WI和动态增强扫描是检测再生结节较敏感的序列,检出率分别为93.9%和96.3%,磁敏感成像(SWI)的检出率稍低(69.5%);再生结节(RN)与低级不典型增生结节(LGDN)(χ2=8.348,P=0.004)、高级不典型增生结节(HGDN)与肝细胞癌(HCC)(χ2=4.612,P=0.032)的MRI诊断符合率差异均有统计学意义。T1WI图像上LGDN的信噪比(SNR)值与RN、HGDN、HCC比较差异均有统计学意义(P值均<0.05);T2WI图像上HCC的SNR值与RN、LGDN、HGDN比较差异均有统计学意义(P值均<0.05)。结论:MRI是目前检测肝硬化结节最敏感的无创性检查方法,通过MRI与病理的对照分析,多模态序列从不同角度反映了肝硬化再生结节的影像学特征及演变规律,对肝硬化再生结节的诊断及鉴别诊断具有一定价值。

Objective：Compared to pathology,to explore the multi-modal MR imaging findings of cirrhotic nodules in order to specify the MRI imaging characteristics in different evolving stages and to realize the early diagnosis and differentiation of the cirrhotic regenerative nodules.Methods：50patients with 85 cirrhotic nodules diagnosed with hepatitis b virus were retrospectively collected.MR images with different scan dates were recorded and analyzed with corresponding pathological results.Results：MR detected 82 nodules in all 50 patients and detection rate was 96.5%.T2 WI and dynamic enhanced scan were more sensitive indicators for the detection of cirrhotic nodules and their detection rates were 93.9% and96.3% respectively.The detection rate of SWI was 69.5%.There was a statistical significance of the MRI diagnostic accuracy in RN with LGDN group（χ2=8.348,P=0.004）and in HGDN with HCC group（χ2=4.612,P=0.032）.There was a statistical significance between LGDN SNR value and RN,HGDN,or HCC on T1 weighted imaging;There was also a statistical significance between HCC SNR value and RN,LGDN,or HGDN on T2 weighted imaging.Conclusion：MRI is nowadays the most sensitive and non-invasive approach in detecting cirrhotic nodules with a few qualitative indicators.Its multimodal sequences reflect the imaging features and evolving regularities of the regenerative nodules from different angles,which has certain diagnosis and differentiation values.By comparing MRI features with pathological results,RN,LGDN,HGDN and HCC have certain specificities.