MRI联合应用DWI和DCE扫描序列对HBV相关肝细胞癌功能状态的评估价值

MRI combined with DWI and DCE scanning sequences to evaluate hepatitis B hepatocellular carcinoma and differentiate it from benign lesions with rich blood supply in the liver

目的分析MRI联合应用DWI和DCE扫描序列在HBV相关肝细胞癌(HCC)功能状态的评估价值。方法选取2018年1月至2023年6月入院诊治HBV相关HCC 60例和肝脏富血供良性病变患者49例。HCC患者分为低级别肝癌组(n=39)和高级别肝癌组(n=21)。比较低级别肝癌组和高级别肝癌组灌注成像参数值、HCC组和良性病变组灌注成像参数值,分析不同灌注参数与微血管密度和病理分级的相关系数、不同灌注参数诊断HCC的ROC曲线。结果高级别肝癌组D值和Ve值分别为(0.82±0.56)×10^(-3) mm^(2)/s和0.10±0.04,显著低于低级别肝癌组的(1.43±0.75)×10^(-3) mm^(2)/s和0.29±0.07,差异均有统计学意义(P<0.05)。HCC组D值、D*值、Ktrans和Ve值分别为(0.92±0.59)×10^(-3) mm^(2)/s、(48.14±22.93)×10^(-3) mm^(2)/s、(0.38±0.22)min^(-1)和(0.14±0.06),显著低于良性病变组的(1.83±0.81)×10^(-3) mm^(2)/s、(62.64±32.43)×10^(-3) mm^(2)/s、(0.61±0.25)min^(-1)和(0.38±0.11),差异均有统计学意义(P<0.05)。分析不同灌注参数与微血管密度和病理分级的相关系数可知,Ktrans值、Kep值、D*值和f值与微血管密度显著正相关,Ve值和D值与病理分级显著负相关;分析不同灌注参数诊断HCC的ROC曲线可知,诊断HCC的参数效率顺序为Ktrans>Kep>f>D*>D>Ve。结论IVIM-DWI在评价HCC程度方面略优于DCE-MRI二室模型病理分级,两者联合应用可以提高HCC微循环功能状态和微结构的诊断性能,单独应用也能发挥良好的诊断价值。

Objective To analyze the value of MRI combined with DWI and DCE scanning sequences in the evaluation of hepatitis B hepatocellular carcinoma and the identification of benign lesions with rich blood supply in the liver.Methods A total of 109 patients with hepatitis B-related hepatocellular carcinoma and benign liver lesions who were admitted for diagnosis and treatment between August 2020 and June 2023 were selected.According to whether the patients had liver cancer or not,they were divided into a liver cancer group(n=60)and a benign lesion group(n=49).According to the histologic grade of hepatocellular carcinoma,patients were further divided into a low-grade liver cancer group(n=39)and a high-grade liver cancer group(n=21).The perfusion imaging parameters of the low-grade and high-grade liver cancer groups,and the liver cancer and benign lesion groups were compared.The correlation coefficients between different perfusion parameters and microvascular density and pathological grading were analyzed.Additionally,ROC curves were constructed to evaluate the diagnostic performance of different perfusion parameters for identifying hepatocellular carcinoma.Results The values of perfusion imaging parameters in the high-grade liver cancer group can be seen to be significantly lower than those in the low-grade liver cancer group,with D values and Ve values in the high-grade group being(0.82±0.56)×10^(-3) mm^(2)/s and 0.10±0.04,respectively,compared to(1.43±0.75)×10^(-3) mm^(2)/s and 0.29±0.07(P<0.05)in the low-grade group.Comparing the perfusion imaging parameter values between the liver cell carcinoma group and the benign lesion group,the D value,D*value,Ktrans value,and Ve value in the liver cell carcinoma group were(0.92±0.59)×10^(-3) mm^(2)/s,(48.14±22.93)×10^(-3) mm^(2)/s,(0.38±0.22)min^(-1),and(0.14±0.06),respectively,all significantly lower than those in the benign lesion group((1.83±0.81)×10^(-3) mm^(2)/s,(62.64±32.43)×10^(-3) mm^(2)/s,(0.61±0.25)min^(-1),and(0.38±0.11),P<0.05).Analyzing the correlation coefficients between different perfusion parameters and microvessel density and pathological grading,it can be seen that the Ktrans value,Kep value,D*value,and f value were significantly positively correlated with microvessel density,while Ve value and D value were significantly negatively correlated with pathological grading.Analyzing the ROC curve of different perfusion parameters for diagnosing liver cell carcinoma,the efficiency order of parameters for diagnosing liver cell carcinoma is Ktrans>Kep>f>D*>D>Ve.Conclusion The IVIM-DWI technique is slightly superior to the dual-compartment model pathological grading of DCE-MRI in evaluating the degree of hepatocellular carcinoma(HCC).The combined application of both methods can improve the diagnostic performance of HCC microcirculation functional status and microstructure.However,using either method alone can still demonstrate good diagnostic value.