多层螺旋CT与磁共振LAVA增强扫描诊断肝内占位性病变性质效能分析

Qualitative diagnosis of intrahepatic space-occupying lesions by multi-slice spiral CT and enhanced liver acquisition with volume acceleration

目的分析多层螺旋CT与高场强磁共振肝脏三维容积快速扫描(LAVA)诊断肝内占位性病变性质的效能。方法2020年5月~2023年4月我院诊治的160例肝内占位性病变患者,均行多层螺旋CT和LAVA增强扫描,以组织病理学诊断为金标准,计算两种方法的诊断效能。结果在本组160例肝内占位性病变患者中,组织病理学诊断恶性病灶87例,包括肝细胞癌(HCC)79例和肝内胆管细胞癌(ICC)8例,和良性病变73例,包括肝硬化结节46例、肝结节状再生性增生(NRHL)20例和肝脏局灶性结节性增生(FNH)7例;CT扫描诊断恶性病灶77例和良性病灶83例,其中将5例良性肿瘤诊断为恶性肿瘤,将15例恶性肿瘤诊断为良性肿瘤,LAVA增强扫描诊断恶性病灶86例和良性病变74例,其中将3例良性肿瘤诊断为恶性肿瘤,将4例恶性肿瘤诊断为良性肿瘤;CT诊断肝内占位性病变的准确率为87.5%、灵敏度为82.8%,特异度为93.2%,阳性预测值为93.5%和阴性预测值为81.9%,而LAVA增强扫描诊断则分别为95.6%、95.4%、95.9%、96.5%和94.6%,显著优于CT诊断(P<0.05)。结论相较于多层螺旋CT扫描,磁共振LAVA增强可更为准确地判断肝内占位性病变的性质,值得临床深入研究。

Objective The purpose of this study was to analyze the diagnostic performance of multi-slice spiral CT and enhanced liver acquisition with volume acceleration(LAVA)in the diagnosis of patients with intrahepatic space-occupying lesions(SOL).Methods 160 patients with intrahepatic SOL were encountered in our hospital between May 2020 and April 2023,and all underwent enhanced multi-slice spiral CT and LAVA scanning.The diagnostic efficacy of CT and LAVA scanning was analyzed based on the histo-pathological examination as the golden standard.Results Out of the 160 patients with intrahepatic SOL,the histo-pathological diagnosis included 87 malignant lesions(hepatocellular carcinoma in 79 cases and intrahepatic cholangiocarcinoma in 8 cases),and 73 benign lesions(cirrhotic nodules in 46 cases,nodular regenerative hyperplasia of liver in 20 cases and focal nodular hyperplasia in 7 cases;the CT diagnose malignant lesions in 77 cases and benign lesions in 83 cases,misdiagnosing 5 benign lesions into malignant and 15 malignant into benign ones,and the LAVA scan diagnose malignant in 86 cases and benign in 74 cases,misdiagnosing 3 benign lesions into malignant and 4 malignant into benign ones;the accuracy,sensitivity,specificity,positive predictive value and negative predictive value by CT scan were 87.5%,82.8%,93.2%,93.5%and 81.9%,while they were 95.6%,95.4%,95.9%,96.5%and 94.6%,respectively by LAVA scan,superior to those by CT diagnosis(P<0.05).Conclusion The qualitative diagnostic performance by MR LAVA is superior,which might help the clinicians make an appropriate decisions to intervene early.