DCE-MRI联合DWI扫描在肝脏局灶性病变(直径≤3cm)定性诊断中的应用

Application of DCE-MRI Combined with DWI Scan in the Qualitative Diagnosis of Focal Liver Lesions(diameter≤3cm)

目的分析磁共振动态增强扫描(DCE-MRI)联合弥散加权成像(DWI)扫描在肝脏局灶性病变(FLLs)(直径≤3cm)定性诊断中的应用价值。方法选择我院2021年4月至2024年4月收治的50例FLLs患者,均接受DCE-MRI和DWI检查,以穿刺或手术等病理结果为标准,比较不同病理类型动态增强扫描曲线分布情况、在不同弥散敏感系数(b值)下的表观弥散系数(ADC)值,并分析DCE-MRI联合DWI扫描对FLLs定性诊断的价值。结果病理结果显示,50例FLLs患者中13例为肝血管瘤,21例为原发性肝癌,16例为肝脏转移瘤。不同b值下,不同病理类型间ADC值比较均有明显差异(P<0.05),且肝血管瘤组ADC值均明显高于原发性肝癌组和肝脏转移瘤组(P<0.05)。DCE-MRI结果显示,肝血管瘤组曲线以Ⅲ型为主(占比76.92%),原发性肝癌组曲线以Ⅰ型为主(占比66.67%),肝脏转移瘤组曲线以Ⅱ型为主(占比75.00%);三组曲线类型分布情况比较有明显差异(P<0.05),且肝血管瘤组与其他两组间曲线类型分布情况比较均有明显差异(P<0.05)。检查结果显示,DCE-MRI联合DWI扫描对良性、恶性病灶诊断准确率最高,分别是92.31%(12/13)、97.30%(36/37);其次是DCE-MRI扫描,分别是69.23%(9/13)、75.68%(28/37);最低是DWI扫描,分别是61.54%(8/13)、54.05%(20/37)。不同检查方法定性诊断FLLs的灵敏度、准确度比较均有明显差异(P<0.05),且DCE-MRI联合DWI扫描诊断的灵敏度和准确度均明显高于DWI及DCE-MRI单独扫描(P<0.05)。结论在FLLs(直径≤3cm)定性诊断中应用DCE-MRI联合DWI扫描有更高的灵敏度和准确度,利于明确其良恶性质,为临床诊治提供更精确指导。

Objective To analyze the application value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with diffusion-weighted imaging(DWI)in the qualitative diagnosis of focal liver lesions(FLLs)(diameter≤3cm).Methods 50 patients with FLLs in the hospital were selected from April 2021 to April 2024.All patients received DCE-MRI examination and DWI examination.Based on the pathological results such as puncture or surgery,the distribution of dynamic enhanced scan curves of different pathological types and the apparent diffusion coefficient(ADC)values under different diffusion sensitivity coefficients(b values)were compared,and the value of DCE-MRI combined with DWI scan in the qualitative diagnosis of FLLs was analyzed.Results Pathological results showed that among 50 patients with FLLs,there were 13 cases of hepatic hemangioma,21 cases of primary liver cancer and 16 cases of liver metastasis.Under different b values,there were significant differences in ADC values among different pathological types(P<0.05),and the ADC values in hepatic hemangioma group were significantly higher than those in primary liver cancer group and liver metastasis group(P<0.05).DCE-MRI showed that the curve of hepatic hemangioma group was mainly type III(76.92%),the curve of primary liver cancer group was mainly type I(66.67%),and the curve of liver metastasis group was mainly type II(75.00%).There was a significant difference in the distribution of curve types among the three groups(P<0.05),and a significant difference was shown in curve type distribution between the hepatic hemangioma group and the other two groups(P<0.05).Examination results showed that the diagnostic accuracy rates for benign lesions and malignant lesions were highest by DCE-MRI combined with DWI scan[92.31%(12/13)and 97.30%(36/37)],followed by DCE-MRI scan[69.23%(9/13)and 75.68%(28/37)],and the lowest was DWI scan[61.54%(8/13)and 54.05%(20/37)].The sensitivity and accuracy of qualitative diagnosis of FLLs by different examination methods were significantly different(P<0.05),and the sensitivity and accuracy of DCE-MRI combined with DWI scan were significantly higher than those of DWI or DCE-MRI alone(P<0.05).Conclusion The application of DCE-MRI combined with DWI scan in the qualitative diagnosis of FLLs(diameter≤3cm)has high sensitivity and accuracy,and it is conducive to clarifying its benign and malignant properties,and providing more accurate guidance for clinical diagnosis and treatment.