体素内非相干弥散加权成像对肝癌与肝脏局灶性结节增生的鉴别诊断价值

Differential diagnostic value of IVIM-DWI in hepatocellular carcinoma and hepatic focal nodular hyperplasia

目的探讨体素内非相干弥散加权成像(IVIM-DWI)对肝癌与肝脏局灶性结节增生(hFNH)的鉴别诊断价值。方法回顾性分析53例肝癌患者(肝癌组)和35例hFNH患者(hFNH组)的临床资料。所有患者均接受肝脏磁共振成像(MRI)平扫、增强扫描及IVIM-DWI检查。观察肝癌与hFNH的图像特征,重点分析两组患者的表观弥散系数(ADC)值、D值、D*值及f值的差异。观察受试者工作特征(ROC)曲线,比较ADC值、D值、D*值、f值诊断肝癌和h FNH的曲线下面积、最佳阈值、灵敏度、特异度。结果肝癌组患者有肝硬化的比例明显高于hFNH组(50.94%vs 20.00%),肝癌组患者中心瘢痕的比例明显低于hFNH组(24.53%vs 57.14%),差异均有统计学意义(P﹤0.01)。肝癌组患者的ADC值、D值、D*值、f值分别为(1.19±0.42)×10^(-3)mm^2/s、(0.98±0.34)×10^(-3)mm^2/s、(35.66±14.61)×10^(-3)mm^2/s、(22.65±9.35)%,均明显低于hFNH组的(1.64±0.71)×10^(-3)mm^2/s、(1.53±0.66)×10^(-3)mm^2/s、(62.54±27.55)×10^(-3)mm^2/s、(30.68±13.99)%,差异均有统计学意义(P﹤0.01)。D值诊断肝癌和hFNH的灵敏度及特异度最高,曲线下面积最大,其最佳阈值为1.06×10^(-3)mm^2/s;其次为ADC值,f值的诊断效能最低。结论 IVIMDWI对肝癌及hFNH鉴别诊断具有重要的意义;通过测量D值、D*值及f值,可以鉴别诊断肝癌及hFNH,其中D值诊断效能最高。

Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging(IVIMDWI)in differential diagnosis of hepatocellular carcinoma and hepatic focal nodular hyperplasia(hFNH).Method The clinical data of 53 patients with hepatocellular carcinoma(hepatocellular carcinoma group)and 35 patients with hFNH(hFNH group)were analyzed retrospectively.Magnetic resonance imaging(MRI)plain scan,enhanced scan and IVIMDWI examination were performed in all patients.The image characteristics of hepatocellular carcinoma and hFNH were observed and the difference of apparent diffusion coefficient(ADC)value,D value,D*value and f value between hepatocellular carcinoma and hFNH were analyzed.The receiver operating characteristic(ROC)curve was observed,the area under the curve,optimal threshold value,sensitivity and specificity at ADC value,D value,D*value and f value between two groups were compared.Result The proportion of liver cirrhosis in patients with hepatocellular carcinoma was higher than that of patients with hFNH(50.94%vs 20.00%),and the proportion of central scar patients with hepatocellular carcinoma was lower than that of patients with hFNH(24.53%vs 57.14%),the differences were statistically significant(P<0.01).The ADC value,D value,D*value and f value of hepatocellular carcinoma were(1.19±0.42)×10^-3 mm^2/s,(0.98±0.34)×10^-3 mm^2/s,(35.66±14.61)×10^-3 mm^2/s and(22.65±9.35)%respectively,which were significantly lower than those of hFNH as(1.64±0.71)×10^-3 mm^2/s,(1.53±0.66)×10^-3 mm^2/s,(62.54±27.55)×10^-3 mm^2/s and(30.68±13.99)%,the differences were statistically significant(P<0.01).The sensitivity and specificity of D value for the diagnosis of hepatocellular carcinoma and hFNH were the highest,with the largest area under the curve and the optimum threshold at 1.06×10^-3 mm^2/s.The second was at the ADC value,and the lowest diagnostic efficacy was at the f value.Conclusion IVIM-DWI is of great significance for the differential diagnosis of hepatocellular carcinoma and hFNH,and the D value is the most effective.