高场磁共振多b值弥散加权成像鉴别诊断肝血管瘤与肝细胞癌价值探讨

Differential diagnosis of hepatic hemangioma and hepatocellular carcinoma by multi-b-value diffusion-weighted imaging of high-field magnetic resonance

目的探讨高场磁共振多b值弥散加权成像(DWI)鉴别诊断肝血管瘤(HH)与肝细胞癌(HCC)的价值.方法2019年6月~2021年5月我院收治的85例肝脏局灶性占位性病变(FLL)患者,均接受高场MRI检查,记录不同b值下表观扩散系数(ADC).均接受肝叶切除术,行组织病理学检查.绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估ADC的鉴别诊断价值.结果在85例FLL患者中,术后组织病理学检查诊断为HH者28例(32.9%)、肝局灶性结节性增生(FNH)者18例(21.2%)和肝细胞癌(HCC)者39例(45.9%);在b值=50 s/mm2、b值=400 s/mm2和b值=1000 s/mm2时,HCC病灶ADC值分别为(2.41±0.20)×10^(-3)/mm^(2)/s、(2.02±0.19)×10^(-3)/mm^(2)/s和(1.73±0.15)×10^(-3)/mm^(2)/s,FNH病灶分别为(2.43±0.31)×10^(-3)/mm^(2)/s、(2.05±0.21)×10^(-3)/mm^(2)/s和(2.01±0.18)×10^(-3)/mm^(2)/s,均显著低于HH病灶[分别为(2.63±0.35)×10^(-3)/mm^(2)/s、(2.46±0.32)×10^(-3)/mm^(2)/s和(2.25±0.23)×10^(-3)/mm^(2)/s,P<0.05];根据b值=1000 s/mm2时HH与HCC病灶ADC值绘制ROC曲线,结果显示,以高场磁共振ADC=1.73×10^(-3)/mm^(2)/s为最佳截断点,其鉴别HH与HCC的AUC(95%CI)为0.727(0.581~0.844,P<0.05),约登指数为0.559,其灵敏度为80.0%,特异度为75.9%.结论采用高场磁共振DWI鉴别诊断HH与HCC病灶具有很大的临床价值,我们推荐应用b值为1000s/mm2时高场磁共振DWI可能鉴别诊断价值更高.

Objective The aim of this study was to investigate the differential diagnosis of hepatic hemangioma(HH)and hepatocellular carcinoma(HCC)by multi-b-value diffusion-weighted imaging(DWI)of high-field magnetic resonance(MR).Methods 85 patients with focal space-occupying liver lesions(FLL)were encountered in our hospital between June 2019 and May 2021,and all underwent high-field magnetic resonance and the apparent diffusion coefficient(ADC)was recorded.All patients received hepatectomy,and the histopathological examination was performed.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to testify the differential diagnosis performance of ADC value for HH and HCC.Results The results of pathological examination post-operationally showed that among the 85 patients with FLL,the HH was found in 28 cases(32.9%),the focal liver nodular hyperplasia(FNH)was found in 18 cases(21.2%)and the HCC was found in 39 cases(45.9%);the ADC of cancerous foci at b=50 s/mm 2,b=400 s/mm 2 and b=1000 s/mm 2 were(2.41±0.20)×10^(-3)/mm^(2)/s,(2.02±0.19)×10^(-3)/mm^(2)/s and(1.73±0.15)×10^(-3)/mm^(2)/s,the ADC of FNH foci were(2.43±0.31)×10^(-3)/mm^(2)/s,(2.05±0.21)×10^(-3)/mm^(2)/s and(2.01±0.18)×10^(-3)/mm^(2)/s,all significantly lower than[(2.63±0.35)×10^(-3)/mm^(2)/s,(2.46±0.32)×10^(-3)/mm^(2)/s and(2.25±0.23)×10^(-3)/mm^(2)/s,respectively,P<0.05]in HH foci;the ROC was drawn based on ADC at b=1000 s/mm 2,and the ADC=1.73×10^(-3)/mm^(2)/s was set as the optimal cut-off-value for differential diagnostic of HH and HCC,the performance is excellent with the AUC(95%CI)of 0.727(0.581-0.844,P<0.05),the sensitivity of 80.0%and the specificity of 75.9%.Conclusion The high-field magnetic resonance imaging has a great importance in the differential diagnosis of hepatic hemangioma and hepatocellular carcinoma,and we recommend the ADCs at b equal to 1000s/mm 2,which needs further clinical investigation.