DCE-MRI、DWI与多层螺旋CT增强扫描在鉴别诊断肝血管瘤、肝转移癌中的应用价值

Application of DCE-MRI,DWI,and Multislice Spiral CT Enhancement Scanning in the Differential Diagnosis of Hepatic Hemangioma and Liver Metastatic Carcinoma

【目的】探讨磁共振动态增强扫描(DCE-MRI)、弥散加权成像(DWI)、多层螺旋CT增强扫描(MSCT)在肝血管瘤及肝转移癌鉴别诊断中的价值。【方法】38例肝脏转移癌患者作为转移组,32例肝血管瘤患者作为血管瘤组,患者均在手术之前接受DEC-MRI、DWI、MSCT检查。比较两组患者的影像学特征差异,并以病理学检查结果作为金标准,分别与三种检查方式绘制2×2四格表计算诊断学价值指标。【结果】血管瘤组的动脉期强化和门静脉强化患者占比均显著低于转移组,延迟期高信号患者占比显著高于转移组(P<0.05);血管瘤组患者DWI检查的表观弥散系数(ADC)值均显著高于转移组(P<0.05);术前MSCT检查显示,血管瘤组患者的病灶平均通过时间、肝血容量、毛细血管表面通透性测定值均高于转移组(P<0.05);病灶动脉灌注量、肝血流量测定值小于转移组(P<0.05)。DCE-MRI鉴别诊断肝转移癌及血管瘤的灵敏度为76.32%、特异度为87.50%;DWI的灵敏度为78.95%、特异度为90.63%;MSCT的灵敏度为71.05%、特异度为93.75%;三者联合鉴别诊断的灵敏度为92.11%、特异度为87.50%。【结论】DCE-MRI、DWI、MSCT联合应用鉴别诊断肝转移癌及血管瘤的灵敏度较高,同时具有较高的特异度。

【Objective】To discuss the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),diffusion-weighted imaging(DWI),and multislice spiral CT(MSCT)enhancement scanning in the differential diagnosis of hepatic hemangioma and liver metastatic carcinoma.【Methods】Thirty-eight patients with liver metastatic carcinoma were enrolled in the metastasis group,and thirty-two patients with hepatic hemangioma were recruited in the hemangioma group.All patients received examination of DCE-MRI,DWI,and MSCT before surgery.According to pathology diagnosis as gold standard,the imaging characteristics of the two groups were compared,and diagnostic value of indicators were calculated by drawing 2×2 contingency tables for each type of examination.【Results】The proportion of patients in the hemangioma group with arterial enhancement and portal venous enhancement was significantly lower than that in the metastasis group,and the proportion of patients in the hemangioma group with high signal in the delay phase was significantly higher than that in the metastasis group(P<0.05).The ADC value of DWI in the hemangioma group were significantly higher than that in the metastasis group(P<0.05).Preoperative MSCT examination showed that the mean transit time,liver blood volume,and capillary surface permeability measurements of the hemangioma group were higher than those of the metastasis group(P<0.05),while lesion arterial perfusion and liver blood flow measurements in the hemangioma group were lower than those in the metastasis group(P<0.05).The sensitivity and specificity of DCE-MRI for differentiating liver metastatic carcinoma and hemangioma were 76.32%and 87.50%,respectively;The sensitivity and specificity of DWI were 78.95%and 90.63%,respectively;And the sensitivity and specificity of MSCT were 71.05%and 93.75%,respectively.The sensitivity of the three combined differential diagnosis of liver metastatic carcinoma and hemangioma was 92.11%and the specificity was 87.50%.【Conclusion】The combined application of DCE-MRI,DWI,and MSCT in the differential diagnosis of liver metastatic carcinoma and hepatic hemangioma can significantly improve sensitivity while maintaining high specificity.