动态增强磁共振成像定量参数鉴别诊断肝脏小占位性病变良恶性价值研究

DCE-MRI quantitative parameters in differentiating malignant from benign small intrahepatic space-occupying lesions

目的 研究动态增强磁共振成像(DCE-MRI)定量参数鉴别诊断肝脏小占位性病变良恶性的价值。方法 2020年3月~2022年3月我院收治的肝脏占位性病变患者83例,纳入病灶≤3(2.2±0.3)cm。所有患者接受DCE-MRI检查,应用Tissue4D软件获得容量转移常数(Ktrans)、速率常数(Kep)、血管外细胞外容积分数(Ve)和增强曲线下初始面积(IAUC)参数。经手术或穿刺组织病理学检查确定诊断。应用受试者工作特征曲线(ROC)分析DCE-MRI定量参数的诊断效能。结果 在本组83例肝内占位性病变患者中,经病理学检查诊断良性病灶38例,恶性病灶45例;恶性病灶Krans、Kep、Ve和IAUC分别为(0.4±0.2)min^(-1)、(0.9±0.3)min^(-1)、(0.5±0.2)和(37.2±7.1),显著大于病灶周围肝组织【分别为(0.1±0.1)min^(-1)、(0.4±0.2)min^(-1)、(0.3±0.1)和(11.1±2.9),P<0.05】,也显著大于良性病灶【分别为(0.2±0.1)min^(-1)、(0.4±0.3)min^(-1)、(0.3±0.2)和(22.1±5.7),P<0.05】;经ROC曲线分析显示,应用Krans、Kep、Ve和IAUC联合判断肝脏小占位性病变良恶性的AUC为0.920,其灵敏度为95.0%,特异度为78.5%,显著高于参数单独诊断(P<0.05)。结论 DCE-MRI定量参数可有效鉴别肝脏小占位性病变的性质,具有很大的临床应用价值。

Objective The aim of this study was to investigate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)quantitative parameters in the differential diagnosis of small benign and malignant liver space-occupying lesions(LSOL).Methods 83 patients with LSOL were admitted to our hospital between March 2020 and March 2022,the patients included had their liver lesions less than 3 cm,and all underwent DCR-MRI scan to obtain the volume transfer constant(Ktrans),rate constant(Kep),extravascular extracellular volume fraction(Ve)and initial area under the curve(IAUC)by Tissue4D software automatically at region of interest.The diagnosis was pathologically confirmed from post-operational or fine needle aspiration tissues.The diagnostic efficacy was assessed by the receiver operating characteristic(ROC)curves.Results Out of the 83 patients with LSOL,the pathological examination found benign lesions in 38 cases and malignant ones in 45 cases;the Krans,Kep,Ve and IAUC in malignant lesions were(0.4±0.2)min^(-1),(0.9±0.3)min^(-1),(0.5±0.2)and(37.2±7.1),all significantly greater than[(0.1±0.1)min^(-1),(0.4±0.2)min^(-1),(0.3±0.1)and(11.1±2.9),respectively,P<0.05]in their adjacent liver tissues,and also much greater than[(0.2±0.1)min^(-1),(0.4±0.3)min^(-1),(0.3±0.2)and(22.1±5.7),respectively,P<0.05]in benign lesions;the ROC analysis showed that the combination of Krans,Kep,Ve and IAUC in differentiating small intrahepatic LSOL was much superior to any parameter alone,with the AUC of 0.920,the sensitivity of 95.0%,and the specificity of 78.5%(P<0.05).Conclusion The DCE-MRI quantitative parameters are efficacious in the differential diagnosis of small benign and malignant intrahepatic LSOL.