磁共振动态增强联合弥散加权成像在肝结节性病变与小肝癌鉴别诊断中应用研究

Application of Dynamic Contrast-enhanced Magnetic Resonance Imaging Combined with Diffusion-weighted Imaging in the Differential Diagnosis of Hepatic Nodular Lesions and Small Hepatocellular Carcinoma

目的:探讨在肝结节性病变与小肝癌鉴别诊断中应用磁共振动态增强(DCE-MRI)联合弥散加权成像(DWI)的价值。方法:纳入2019年1月-2021年1月于某院就诊的肝脏占位性病变患者102例,所有患者均行DCE-MRI、DWI检查。观察影像学表现,比较两种检查方法对病灶的检出率,并以手术组织病理学检查结果为金标准,分析DCE-MRI联合DWI在小肝癌与肝结节性病变的鉴别价值。结果:良性肝结节性病变T_(1)WI呈低或稍低信号,T_(2)WI呈高或略高信号,DWI呈略高信号,LAVA门静脉及延迟期强化减退,动脉期有强化;小肝癌T_(1)WI呈低信号,T_(2)WI和DWI呈高或略高信号,LAVA门静脉期及延迟期信号低,动脉期强化显著,呈现典型“快进快出”;DCE-MRI、DWI联合检测病灶检出率高于DCE-MRI、DWI单一检测,有统计学差异(P<0.05)。DCE-MRI、DWI检测敏感度比较,无统计学差异(P>0.05);DCE-MRI、DWI二者联合检测敏感度、准确度分别为97.83%、97.06%,明显高于DCE-MRI单项检测的78.26%、85.29%和DWI单项检测的82.61%、89.22%,有统计学差异(P<0.05)。结论:DCE-MRI联合DWI检查可有效鉴别诊断肝结节性病变与小肝癌,利于提高诊断准确性,为临床治疗提供可靠的依据。

Objective:To investigate the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with diffusion-weighted imaging(DWI)in the differential diagnosis of hepatic nodular lesions and small hepatocellular carcinoma.Methods:A total of 102 patients with liver space-occupying lesions who were treated in a hospital from January 2019 to January 2021 were included,and all patients underwent DCE-MRI and DWI examinations.The imaging manifestations were observed,the detection rate of the two methods was compared,and the results of surgical histopathology were used as the gold standard to analyze the differential value of DCE-MRI combined with DWI in small hepatocellular carcinoma and liver nodular lesions.Results:Benign hepatic nodular lesions showed low or slightly low T_(1)WI signal,high or slightly high T_(2)WI signal,and slightly high DWI signal,LAVA portal vein phase and delayed phase enhancement decreased,and arterial phase strengthened;Small hepatocellular carcinoma showed low T_(1)WI signal,high or slightly high signal T_(2)WI and DWI signal,low signal in LAVA portal vein phase and delayed phase,significant enhancement in arterial phase,showing typical"fast in and fast out";The detection rate of lesions detected by DCE-MRI combined with DWI was higher than that of DCE-MRI and DWI single test,with statistical difference(P<0.05).There was no statistical difference in the detection sensitivity of DCE-MRI and DWI(P>0.05).The combined detection sensitivity and accuracy of DCE-MRI and DWI were 97.83%and 97.06%,respectively,which were significantly higher than the single detection of DCE-MRI(78.26%,85.29%)and DWI(82.61%,89.22%),with statistical difference(P<0.05).Conclusion:DCE-MRI combined with DWI examination can effectively differentiate the diagnosis of hepatic nodular lesions and small hepatocellular carcinoma,which is beneficial to improve the diagnostic accuracy and provide a reliable basis for clinical treatment.