联合ADC值及VIBE-DCE技术对消化道癌肝转移瘤的诊断价值

Diagnostic Value of DWI and VIBE-DCE Technique in Liver Metastases of Digestive Tract Carcinoma

目的探讨磁共振扩散加权成像(Diffusion weighted imaging,DWI)表观扩散系数(Apparent diffusion coefficient,ADC)结合容积内插屏气扫描(Volume interpolated breath hold examination,VIBE)动态增强(Dynamic contrast enhancement,DCE)技术对消化道癌肝转移瘤的诊断价值。方法对临床确诊为消化道癌并怀疑肝转移的40例患者进行MR扫描,扫描序列包括T1WI和T2WI、T2WI FS及DWI(b值=0,300,600s/mm2)及VIBE-DCE扫描。将40例图像资料分成A、B、C三组:A组(T1WI、T2WI、T2WI FS和DWI),B组(T1WI、T2WI、T2WI FS和VIBEDCE),C组(T1WI、T2WI、T2 WIWI、DWI-IVIM和VIBE-DCE),观察各组序列肝转移瘤的信号特征,计算各组对肝转移瘤的准确度、特异度、灵敏度、阳性预测值、阴性预测值以及对转移瘤病灶检出率的差异。结果 40例消化道癌肝转移的患者中,经病理或临床随访明确诊断转移瘤共93个,A组共检出转移病灶77个,漏诊16个,误诊7个,B组共检出转移病灶79个,漏诊14个,误诊6个,C组共检出转移病灶91个,漏诊2个,误诊0个,A、B、C各组的准确度、特异度、灵敏度、阳性预测值、阴性预测值分别为(82.31%vs 84.62%vs 96.92%)、(81.08%vs 83.78%vs97.22%)、(82.80%vs 84.95%vs 97.85%)、(91.67%vs 92.94%vs 98.91%)、(65.22%vs 68.89%vs 94.59%)。A、B组之间对消化道癌转移瘤的检出率无显著性意义(P> 0.05),C组与A、B组之间差异存在统计学意义(P <0.05)。结论联合ADC值、VIBE-DCE及常规序列,可以提高肝脏转移瘤检出率,尤其在早期微小病灶(<1 cm)和不典型病灶检出率和准确率方面有重要价值。

Objective To investigate the diagnostic value of Apparent diffusion coefficient( ADC) of diffusion weighted imaging( DWI) combined with Volume interpolated breath hold examination( VIBE) dynamic enhancement( DCE)technology in liver metastases of digestive tract carcinoma. Methods MR scan was performed on 40 patients with clinically diagnosed gastrointestinal cancer and suspected liver metastasis,including T1WI,T2WI,T2WI FS,DWI( b value = 0,300,600 s/mm2) and VIBE-DCE. The imaging date of 40 cases was divided into 3 groups: Group A( T1WI,T2WI,T2WI FS and DWI),Group B( T1WI,T2WI,T2WI FS and VIBE-DCE),and Group C( T1WI,T2WI,T2WI FS,DWI-IVIM and VIBE-can DCE). The signal characteristics of the digestive tract cancer liver metastases were observed. The specific degree of accuracy,sensitivity,positive predictive value,and negative predictive value of liver metastases for each group were calculated,and the differences in the detection rate of the lesions in each group were compared. Results In the 40 patients with liver metastases from digestive tract carcinoma,93 metastatic tumors were confirmed by pathological or clinical follow-up. In Group A,77 metastatic lesions were detected,16 were misdiagnosed,and 7 were misdiagnosed. In Group B,79 were detected,14 were misdiagnosed,6 were misdiagnosed. In Group C,91 metastatic lesions were detected,2 were misdiagnosed,0 were misdiagnosed. The values of accuracy,specificity,sensitivity,positive predictive value and negative predictive value of Groups A,B and C were( 82. 31% vs 84. 62% vs 96. 92%),( 81. 08% vs 83. 78% vs 97. 22%),( 82. 80% vs84. 95% vs 97. 85%),( 91. 67% vs 92. 94% vs 98. 91%),( 65. 22% vs 68. 89% vs 94. 59%). The detection rate of liver metastases of digestive tract carcinoma was not significant between Group A and B( P > 0. 05),but the difference between Group C and Group A and B was statistically significant( P < 0. 05). Conclusion Combined with DWI ADC value,VIBE-DCE and routine sequence,the detection rate of liver metastases of digestive tract carcinoma can be improved,and it is particularly valuable for the detection and accuracy of early small lesions( < 1 cm) and atypical lesions.