ADC定量对鉴别肝血管周上皮样肿瘤与肝细胞癌的价值

The value of ADC quantification in differentiating hepatic perivascular epithelioid cell tumor from hepatocellular carcinoma

目的探讨通过ADC值区分肝血管周上皮样细胞肿瘤(PEComa)与肝细胞癌(HCC)的可能性。方法收集2015年1月~2022年12月经手术病理证实的17例肝PEComa临床及MRI资料,其中男6例,女11例,年龄29~69岁(中位年龄39岁)。另外匹配同期经手术病理证实的HCC病例45例,分为2组,HCC-A组19例(无乙肝病史、肝硬化、转移和/或癌栓,血清甲胎蛋白阴性),HCC-B组26例(有乙肝病史,轻度肝硬化,无转移和/或癌栓,血清甲胎蛋白阴性)。所有患者均有完整3.0 T磁共振平扫加普美显(钆塞酸二钠)增强及DWI资料,DWI扫描采用4个b值(0、50、400、800 s/mm^(2)),ADC图自动产生。回顾性分析三组病例的临床资料、磁共振平扫及增强特点、肝胆特异期对比剂的摄取及肿瘤定量ADC值。结果肝PEComa组增强模式表现为“快进快出”的比例为94.1%(16/17),与HCC-A组(84.2%,16/19)、HCC-B组(92.3%,24/26)相比差异无统计学意义(P>0.05);肝胆特异期无对比剂摄取的比率三组依次为82.4%(14/17)、73.7%(14/19)、46.2%(12/26),两两相较差异无统计学意义(P>0.05)。DWI上肿瘤最受限区域ADC定量分析,三组ADC值依次为(791.9±298.8)×10^(-3) mm^(2)/s、(576.39±154.61)×10^(-3) mm^(2)/s、(560.71±166.01)×10^(-3) mm^(2)/s,肝PEComa组与任一HCC组均存在显著性统计学差异(P<0.05),ADC值鉴别诊断肝PEComa和HCC的诊断界值为785.75×10^(-3) mm^(2)/s[(608~968)×10^(-3) mm^(2)/s],诊断敏感度76.5%和特异度为95.0%。结论磁共振成像ADC定量可单独用于鉴别肝PEComa与HCC,具有较高的诊断效能,有助于简化检查方案。

Objective To distinguish hepatic perivascular epithelioid cell tumor(PEComa)from hepatocellular carcinoma(HCC)by ADC value.Methods The clinical and MRI imaging data of 17 patients(6 men,11 women;age range:29-69 years,mean:39)with hepatic PEComa confirmed by surgery and pathology from January 2015 to December 2022 were collected.In addition,45 HCC patients confirmed by surgery and pathology during the same period were matched,who were divided into group HCC-A(19 patients,with no history of hepatitis B,liver cirrhosis,metastasis and tumor thrombus,serum AFP negative)and group HCC-B(26 patients with history of hepatitis B,mild liver cirrhosis,no metastasis and tumor thrombus,serum AFP negative).All patients underwent nonenhanced and Gd-EOB-DTPA enhanced 3.0 T MRI scans.Four b-values(0,50,400,800 s/mm^(2))were used in DWI scan,and the ADC maps were generated automatically.The clinical and imaging features were retrospectively analyzed,and the quantitative ADC value of the tumor were analyzed.Results 94.1%of hepatic PEComa group showed the enhancement mode of“fast in and fast out”(16/17),there was no significant difference with HCC-A group(84.2%,16/19)or HCC-B group(92.3%,24/26),P>0.05.The ratio of no contrast agent uptake in liver and biliary specific period was 82.4%(hepatic PEComa group,14/17),73.7%(HCC-A group,14/19),46.2%(HCC-B group,12/26),and there was no significant difference in pairwise comparison(P>0.05).The quantitative analysis of ADC in the most restricted area of tumor with DWI sequence showed that:the ADC value of hepatic PEComa group was(791.9±298.8)×10^(-3) mm^(2)/s,HCC-A group was(576.39±154.61)×10^(-3) mm^(2)/s,HCC-B group was(560.71±166.01)×10^(-3) mm^(2)/s.There were statistically significant difference between PEComa group with either HCC-A group and HCC-B group(P<0.05).The cut-off value of ADC value for the differential diagnosis of hepatic PEComa and HCC was 785.75×10^(-3) mm^(2)/s[(608~968)×10^(-3) mm^(2)/s],with a sensitivity of 76.5%and a specificity of 95.0%.Conclusion Quantitative ADC analysis of MRI can be used to differentiate hepatic PEComa from HCC,which has high diagnostic efficacy and can helps to simplify the examination scheme.