DCE-MRI联合DWI在小肝癌与肝硬化结节鉴别诊断中的应用价值研究

Study on the Application Value of DCE-MRI Combined with DWI in the Differential Diagnosis of Small Hepatocellular Carcinoma and Cirrhotic Liver Nodules

目的:探讨磁共振动态增强技术(DCE-MRI)联合弥散加权成像(DWI)在小肝癌与肝硬化结节鉴别诊断中的应用价值。方法:选取2019年1月—2021年12月驻马店市中医院收治的98例肝占位性病变患者(共151个病灶)作为研究对象,采用多模态磁共振成像(MRI)对不典型肝硬化结节与小肝癌进行鉴别诊断。分析小肝癌与肝硬化结节的DCE-MRI成像特点,比较小肝癌患者与肝硬化结节患者各项参数,并采用受试者工作特征(ROC)曲线分析DCE-MRI联合DWI在小肝癌与肝硬化结节鉴别诊断中的应用价值。结果:经细针穿刺或手术切除病理学检查,98例肝硬化伴肝内结节病变患者中发现小肝癌54例(55.10%),肝硬化结节44例(44.90%);术后病理确诊为中分化肝占位性病变,增强强化方式不典型。小肝癌患者的ADC值、D值均低于肝硬化结节患者,差异有统计学意义(t=2.972、3.092,P<0.05)。DCE-MRI联合DWI对肝硬化结节与小肝癌诊断的准确度、灵敏度高于单独诊断,差异有统计学意义(χ^(2)=4.923、5.234、1.144,P<0.05)。结论:DCE-MRI联合DWI检测可显著提高小肝癌与肝硬化结节鉴别诊断能力,但单独诊断价值有限。

Objective:To investigate the value of magnetic resonance dynamic enhancement technique(DCE-MRI)combined with diffusion-weighted imaging(DWI)in the differential diagnosis of small hepatocellular carcinoma and cirrhotic nodules.Methods:98 patients with liver-occupying lesions(151 lesions in total)admitted to the hospital from January 2019 to December 2021 were selected for the study,and multimodal magnetic resonance imaging(MRI)was used for the differential diagnosis of atypical cirrhotic nodules and small hepatocellular carcinomas.The imaging characteristics of DCE-MRI in small hepatocellular carcinoma and cirrhotic nodules were analyzed,the parameters were compared between patients with small hepatocellular carcinoma and those with cirrhotic nodules,and the value of DCE-MRI combined with DWI in the differential diagnosis of small hepatocellular carcinoma and cirrhotic nodules was analyzed by using the subject’s work characteristic(ROC)curve.Results:On pathologic examination by fine-needle aspiration or surgical resection,54(55.10%)small hepatocellular carcinomas and 44(44.90%)cirrhotic nodules were found in 98 patients with cirrhosis associated with intrahepatic nodular lesions,and postoperative pathology confirmed the diagnosis of moderately differentiated hepatic space-occupying lesions with an atypical pattern of enhancement.The ADC and D values of patients with small hepatocellular carcinoma were lower than those of patients with cirrhotic nodules,and the difference was statistically significant(t=2.972,3.092,P<0.05).The accuracy and sensitivity of DCE-MRI combined with DWI for the diagnosis of cirrhotic nodules and small hepatocellular carcinoma were higher than that of diagnosis alone,and the difference was statistically significant(χ^(2)=4.923,5.234,1.144,P<0.05).Conclusion:DCE-MRI combined with DWI testing significantly improves the differential diagnosis of small hepatocellular carcinomas from cirrhotic nodules,but has limited diagnostic value alone.