原发性肝癌的中医证型与肝脏特异性对比剂影像表现相关性研究

Study on the Correlation Between the TCM Syndrome Types of Primary Liver Cancer and the Imaging Manifestations of Liver Specific Contrast Agent

目的:分析原发性肝癌的中医证型与MRI肝脏特异性对比剂影像表现的相关性。方法:150例原发性肝癌患者均接受MRI检查,对病灶的大小、数目、强化程度等方面进行评价并记录病变的表观扩散系数(apparentdiffusioncoefficient,ADC),分析MRI影像表现和中医证型之间的联系。结果:气滞证、血瘀证、脾虚证、湿热证、阴虚证等5种中医证型患者肿瘤大小比较,差异有统计学意义(P<0.05);气滞证、血瘀证、脾虚证、湿热证、阴虚证等5种中医证型患者肿瘤数量比较,差异无统计学意义(P>0.05)。肝脏特异性对比剂增强扫描后,肝胆期信号强度随着肝功能衰减呈现减弱趋势,同时随着患者肝功能下降,肝实质信号增强程度(IS%)呈降低趋势(P<0.05),不同中医证型组增强前后肝脏的IS%比较,差异无统计学意义(P>0.05)。气滞证、脾虚证、阴虚证3种证型DWI信号相对较高,ADC信号相对较低;血瘀证、湿热证两种证型DWI信号较低,ADC信号较高。结论:运用MRI影像学技术对细微病灶进行观察能够为原发性肝癌的临床中医辨证提供客观化依据,有助于提高中医辨证正确率。

Objective:To analyze the correlation between the TCM syndrome types of primary liver cancer and the imaging manifestations of MRI liver specific contrast agent.Methods:150 patients with primary liver cancer were examined by MRI.The size,number and intensity of the lesions were evaluated and the apparent diffusion coefficient(ADC)of the lesions was recorded.The relationship between MRI manifestations and TCM syndromes was analyzed.Results:Tumor size in patients with 5 TCM syndromes including qi stagnation syndrome,blood stasis syndrome,spleen deficiency syndrome,damp-heat syndrome,and Yin deficiency syndrome were compared.The differences were statistically significant(P<0.05).There were no statistically significant differences in the number of tumors in patients with five TCM syndromes,including qi stagnation syndrome,blood stasis syndrome,spleen deficiency syndrome,damp-heat syndrome,and yin deficiency syndrome(P>0.05).After contrast-enhanced scanning with liver specific contrast agent,the signal intensity of hepatobiliary phase decreased with the decline of liver function,and the signal intensity of liver parenchyma(IS%)decreased with the decline of liver function(P<0.05).There was no significant difference in IS%of liver before and after the enhancement in different TCM syndrome groups(P>0.05).The DWI signal of qi stagnation syndrome,spleen deficiency syndrome and yin deficiency syndrome is relatively high,ADC signal is relatively low;the DWI signal of blood stasis syndrome and damp-heat syndrome is relatively low,and ADC signal is relatively high.Conclusion:Using MRI imaging technology to observe the subtle lesions can provide objective basis for the clinical syndrome differentiation of primary liver cancer,and help to improve the accuracy of TCM syndrome differentiation.