MRI R2^(*)值鉴别肝细胞癌与肝内肿块型胆管癌

MRI R2^(*)value for distinguishing hepatocellular carcinoma and intrahepatic mass-type cholangiocarcinoma

目的观察MRI定量R2^(*)值鉴别肝细胞癌(HCC)与肝内肿块型胆管癌(IMCC)的价值。方法回顾性分析106例HCC(HCC组)及49例IMCC(IMCC组)患者临床和上腹部MRI(包括2D多回波快速梯度回波序列R2^(*)Map图像)资料,比较2组肿瘤R2^(*)值、T2^(*)值、表观弥散系数(ADC)值、肿瘤近旁及远旁肝实质R2^(*)值、竖脊肌R2^(*)值,以及肿瘤与肝实质R2^(*)比值(T/L-R2^(*))和肿瘤与竖脊肌R2^(*)比值(T/M-R2^(*));绘制受试者工作特征曲线,计算曲线下面积(AUC),比较各参数鉴别HCC与IMCC的效能。结果相比IMCC组,HCC组男性、甲胎蛋白≥9 ng/ml、伴肝硬化、有假包膜、瘤内出血、动脉晚期非环形强化及门静脉期非环形廓清者占比均较高,而淋巴结转移者占比较低(P均<0.05)。HCC平均R2^(*)值为(32.58±9.52)Hz,高于IMCC[(21.64±6.64)Hz,P<0.05]。以肿瘤R2^(*)值、T/L-R2^(*)、T/M-R2^(*)及肿瘤T2^(*)值鉴别HCC与IMCC的效能差异均无统计学意义(P均>0.05)而均高于ADC值(P均<0.05)。肿瘤R2^(*)值的AUC为0.848;以25.79 Hz为最佳截断值,其鉴别HCC与IMCC的敏感度为77.36%、特异度为85.71%。结论MRI定量R2^(*)值可用于鉴别HCC与IMCC。

Objective To observe the value of MRI quantitative R2^(*)value for distinguishing hepatocellular carcinoma(HCC)and intrahepatic mass-type cholangiocarcinoma(IMCC).Methods Clinical and epigastric MRI(including 2D multi-echo fast gradient recalled echo R2^(*)Map)data of 106 patients with HCC(HCC group)and 49 with IMCC(IMCC group)were retrospectively analyzed.The measurement and comparison of R2^(*)values,T2^(*)values and apparent diffusion coefficient(ADC)values of tumors,R2^(*)values of adjacent or distant hepatic parenchyma,R2^(*)value of erector spinae,as well as of tumor/liver-R2^(*)(T/L-R2^(*))and tumor/muscle-R2^(*)(T/M-R2^(*))were performed.Receiver operating characteristic curves were drawn to assess the diagnostic performance of each parameter for differentiating HCC and IMCC,and the area under the curve(AUC)were calculated and compared.Results The proportions of cases of male,alpha-fetoprotein(AFP)≥9 ng/ml,cirrhosis,presence of pseudo capsule,intratumoral hemorrhage,non-circumferential arterial enhancement during the late arterial phase,and non-circumferential washout in the portal venous phase in HCC group were significantly higher,while of cases with lymph node metastasis was lower compared with those in IMCC group(all P<0.05).The mean tumor R2^(*)value of HCC was(32.58±9.52)Hz,significantly higher than that of IMCC([21.64±6.64]Hz,P<0.05).The diagnostic performances of tumor R2^(*)value,T/L-R2^(*),T/M-R2^(*),and tumor T2^(*)value in distinguishing HCC and IMCC were not significantly different(all P>0.05),but all superior to that of ADC value(all P<0.05).The AUC of tumor R2^(*)value was 0.848.Taken 25.79 Hz as the best cutoff value of tumor R2^(*)value,its sensitivity of discriminating HCC and IMCC was 77.36%,with specificity of 85.71%.Conclusion MRI R2^(*)value was useful for distinguishing HCC and IMCC.