磁共振弥散加权成像检查在肝细胞癌、肝血管瘤鉴别诊断中的价值

Value of Magnetic Resonance Diffusion Weighted Imaging Examination in Differentiate Diagnosis of Hepatocellular Carcinoma and Hepatic Hemangioma

目的:探讨磁共振弥散加权成像(diffusion weighted imaging,DWI)检查在肝细胞癌、肝血管瘤鉴别诊断中的价值。方法:回顾性分析2020年8月—2022年8月贵州茅台医院收治的89例肝脏肿瘤患者的临床资料。所有患者均开展常规磁共振成像(magnetic resonance imaging,MRI)平扫、磁共振DWI检查。以术后病理为金标准。统计常规MRI平扫、磁共振DWI检查对肝细胞癌及肝血管瘤检出情况。分析常规MRI平扫、磁共振DWI检查鉴别诊断肝细胞癌、肝血管瘤的价值。分析常规MRI平扫、磁共振DWI检查与术后病理的一致性。比较肝细胞癌及肝血管瘤患者不同b值平均表观扩散系数(apparent diffusion coefficient,ADC)值。结果:89例肝脏肿瘤患者经术后病理检出肝细胞癌34例,肝血管瘤55例。常规MRI平扫检出肝细胞癌29例,肝血管瘤60例;磁共振DWI检查检出肝细胞癌33例,肝血管瘤56例。磁共振DWI检查的敏感度、准确度均高于常规MRI平扫,差异有统计学意义(P<0.05)。Kappa检验显示,常规MRI平扫与术后病理一致性尚可(Kappa=0.731,P<0.001);磁共振DWI检查与术后病理一致性极好(Kappa=0.928,P<0.001)。肝细胞癌患者50 s/mm^(2)、400 s/mm^(2)、1 000 s/mm^(2)平均ADC值均低于肝血管瘤患者,差异有统计学意义(P<0.05)。结论:磁共振DWI检查在肝细胞癌、肝血管瘤鉴别诊断中价值更高,可提高疾病诊断敏感度、准确度,减少漏诊、误诊发生,以便于更好地指导临床治疗。

Objective:To explore the value of magnetic resonance diffusion weighted imaging(DWI)examination in differentiate diagnosis of hepatocellular carcinoma and hepatic hemangioma.Method:The clinical data of 89 patients with liver tumor admitted to Kweichow Moutai Hospital from August 2020 to August 2022 were retrospectively analyzed.All patients underwent routine magnetic resonance imaging(MRI)plain scan and magnetic resonance DWI examination.Taking the postoperative pathology as the gold standard,detection situation of hepatocellular carcinoma and hepatic hemangioma by routine MRI plain scan and magnetic resonance DWI examination were counted.The value of routine MRI plain scan and magnetic resonance DWI examination in the differentiate diagnosis of hepatocellular carcinoma and hepatic hemangioma was analyzed.The consistency of routine MRI plain scan and magnetic resonance DWI examination with postoperative pathology was analyzed.The average apparent diffusion coefficient(ADC)values of different b values in patients with hepatocellular carcinoma and hepatic hemangioma were compared.Result:Among the 89 patients with liver tumor,34 cases of hepatocellular carcinoma and 55 cases of hepatic hemangioma were detected by postoperative pathology.Routine MRI plain scan showed 29 cases of hepatocellular carcinoma and 60 cases of hepatic hemangioma.Magnetic resonance DWI examination showed 33 cases of hepatocellular carcinoma and 56 cases of hepatic hemangioma.The sensitivity and accuracy of magnetic resonance DWI examination were higher than those of routine MRI plain scan,and the differences were statistically significant(P<0.05).Kappa test showed that routine MRI plain scan was acceptable consistent with postoperative pathology(Kappa=0.731,P<0.001).There was good consistency between magnetic resonance DWI examination and postoperative pathology(Kappa=0.928,P<0.001).The average ADC values of 50 s/mm^(2),400 s/mm^(2),21000 s/mm in patients with hepatocellular carcinoma were lower than those in patients with hepatic hemangioma,and the differences were statistically significant(P<0.05).Conclusion:Magnetic resonance DWI examination is more valuable in the differential diagnosis of hepatocellular carcinoma and hepatic hemangioma,which can improve the sensitivity and accuracy of disease diagnosis,reduce the occurrence of missed diagnosis and misdiagnosis,so as to better guide the clinical treatment.