增强MRI联合IVIM-DWI诊断小肝细胞癌价值研究

Contrast-enhanced MRI and IVIM-DWI in the diagnosis of patients with small hepatocellular carcinoma

目的探讨增强磁共振(MRI)联合体素内不相干运动磁共振扩散加权成像(IVIM-DWI)诊断小肝细胞癌(sHCC)的价值。方法2020年5月~2023年5月我院收治的肝脏局灶性病变患者73例,所有患者均接受增强MRI和IVIM-DWI检查,观察病灶增强强化信号特点,分析病灶IVIM-DWI定量参数,即伪扩散系数(D^(*))、真实扩散系数(D)和灌注分数(f)。采用细针穿刺或取术后组织行病理学检查。应用受试者特征工作曲线(ROC)下面积(AUC)评估增强MRI联合IVIM-DWI诊断sHCC的效能。结果经病理学检查,在73例肝脏局灶性病变患者中,诊断sHCC者49例(67.1%)和肝脏异型性增生结节(DN)者24例(32.9%);sHCC病灶T1WI低信号、T2WI高信号、动脉期强化和肝胆期低信号占比分别为61.2%、83.7%、59.2%和89.8%,均显著高于DN病灶的20.8%、33.3%、25.0%和29.2%(P<0.05);sHCC病灶D*和D分别为(50.9±11.6)×10^(-3) mm^(2)/s和(0.8±0.2)×10^(-3) mm^(2)/s,均显著小于DN病灶【分别为(78.4±15.8)×10^(-3) mm^(2)/s和(1.2±0.3)×10^(-3) mm^(2)/s,P<0.05】,而两组f比较,差异无统计学意义【分别为(45.6±8.7)%对(43.9±9.5)%,P>0.5】;ROC分析表明,应用T1WI信号、T2WI信号、动脉期强化、肝胆期信号、D*和D联合诊断sHCC的AUC为0.968,其灵敏度和特异度分别为100.0%和86.0%。结论应用增强MRI和IVIM-DWI联合诊断sHCC的效能较高,可为临床诊疗提供有益的依据,值得进一步深入研究。

Objective The aim of this study was to explore the diagnostic performance of contrast-enhanced magnetic resonance imaging(MRI)and intravoxel incoherent motion-diffusion weighted imaging(IVIM-DWI)in patients with small hepatocellular carcinoma(sHCC).Methods 73 patients with focal nodular hyperplasia(FNH)were enrolled in our hospital between May 2020 and May 2023,and all patients underwent contrast-enhanced MRI and IVIM-DWI,recording the pseudo diffusion coefficient(D^(*)),true diffusion coefficient(D)and perfusion fraction(f).The fine needle aspiration biopsies or postoperative histopathology were performed for golden diagnosis.The diagnostic efficacy of contrast-enhanced MRI and IVIM-DWI was evaluated by receiver operating characteristic(ROC)curves.Results Among the 73 patients with FNH,the histopathology examination showed sHCC in 49 cases(67.1%)and the dysplastic nodules(DN)in 24 cases(32.9%);the percentages of low signals on T1WI,high signals on T2WI,arterial phase enhancement and low signals during hepatobiliary phase in HCC lesions were 61.2%,83.7%,59.2%and 89.8%,all significantly higher than 20.8%,33.3%,25.0%and 29.2%(P<0.05)in DN lesions;the D^(*) and D in HCC lesions were(50.9±11.6)×10^(-3) mm^(2)/s and(0.8±0.2)×10^(-3) mm^(2)/s,both significantly less than[(78.4±15.8)×10^(-3) mm^(2)/s and(1.2±0.3)×10^(-3) mm^(2)/s,P<0.05]in DN lesions,while there was no significant difference as respect to f between the two lesions[(45.6±8.7)%vs.(43.9±9.5)%,P>0.5];the ROC analysis showed the AUC was 0.968,with the sensitivity of 100.0%and the specificity of 86.0%,when the T1WI and T2WI signals,arterial phase enhancement,hepatobiliary phase signal,D*and D was combined for the diagnosis of sHCC.Conclusion The contrast-enhanced MRI and IVIM-DWI are efficacious in the diagnosis of patients with sHCC,which might provide the clinicians a reliably tool for early differentiation of patients with FNH.