磁共振成像联合超声造影对无瘢痕肝脏局灶性结节的诊断价值

Value of magnetic resonance imaging multimodal parameters combined with contrast-enhanced ultrasound parameters in the diagnosis of focal nodular hyperplasia of liver without scar

目的探讨磁共振成像(MRI)联合超声造影(CEUS)对无瘢痕肝脏局灶性结节增生的诊断价值。方法纳入2016年1月至2023年7月医院收治的无瘢痕肝脏局灶性结节增生患者56例,无肝硬化背景的肝细胞癌患者67例。对比2组患者的一般资料、MRI多模态参数、CEUS参数,分析无瘢痕肝脏局灶性结节增生发生的相关因素,分析各参数联合对无瘢痕肝脏局灶性结节增生发生的诊断价值。结果2组信号增强率(SER)、快速扩散成分占比(f)值对比差异无统计学意义(P>0.05),结节增生组最大下降斜率(MSD)、最大上升斜率(MSI)、快速表观扩散系数(D*)、表观扩散系数(ADC)、快速扩散成分占比(f)、慢速表观扩散系数(D)值均高于肝癌组(P<0.05)。结节增生组峰值强度(PI)低于肝癌组(P<0.05),而达峰时间(TTP)与开始增强时间(AT)高于肝癌组(P<0.05)。logistic回归分析结果显示,MSD(OR=3.943,95%CI:1.733~8.970)、TTP(OR=4.162,95%CI:1.830~9.468)、AT(OR=4.536,95%CI:1.994~10.318)、ADC(OR=3.333,95%CI:1.465~7.583)是影响无瘢痕肝脏局灶性结节增生的相关因素(P<0.05)。MSD、TTP、AT、ADC及4项参数联合诊断无瘢痕肝脏局灶性结节增生的曲线下面积分别为0.815、0.804、0.822、0.793、0.901(P<0.05)。结论MSD、TTP、AT、ADC在诊断无瘢痕肝脏局灶性结节增生中具有重要价值,且4项指标联合的诊断价值更高。

Objective To evaluate the value of magnetic resonance imaging(MRI)multimodal parameters combined with contrast-enhanced ultrasound(CEUS)parameters in the diagnosis of focal nodular hyperplasia of the liver without scar.Methods The clinical data of 56 patients with non-scar focal nodular hyperplasia of liver admitted to the hospital from January 2016 to July 2023 were retrospectively analyzed as the study group,and the clinical data of 67 patients with hepatocellular carcinoma without cirrhosis were retrospectively analyzed as the control group.All subjects underwent the examinations including intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI),MRI,contrast-enhanced ultrasound(CEUS),and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI).By comparing the general data,MRI multimodal parameters and CEUS parameters of the two groups,we analyzed the factors related to the occurrence of cicatricial focal nodular hyperplasia of the liver,as well as the diagnostic value of the combination of parameters for the occurrence of focal nodular hyperplasia in the liver without scar was analyzed.Results There was no difference in signal enhancement rate(SER)and proportion of fast diffusion components(f)between the two groups(P>0.05).The values of maximum slope of decrease(MSD),maximum slope of increase(MSI),rapid apparent diffusion coefficient(D*),apparent diffusion coefficient(ADC),proportion of rapid diffusion components(f)and slow apparent diffusion coefficient(D)in the study group were higher than control group(P<0.05).The study group with peak intensity(PI)was lower than control group(P<0.05),and the study group with peak time(TTP)and start enhancement time(AT)were higher than control group(P<0.05).Logistic regression analysis showed that MSD(OR=3.943,95%CI:1.733~8.970),TTP(OR=4.162,95%CI:1.830~9.468),AT(OR=4.536,95%CI:1.994~10.318)and ADC(OR=3.333,95%CI:1.465~7.583)were associated with the occurrence of focal nodular hyperplasia of liver without scar(P<0.05).The area under the curve(AUC)values of MSD,TTP,AT,ADC and the combined diagnosis of scar-free focal nodular hyperplasia of liver were 0.815,0.804,0.822,0.793 and 0.901,respectively(P<0.05).And the combined AUC was higher(P<0.05).Conclusion MSD,TTP,AT and ADC are of great value in the diagnosis of cicatar-free focal nodular hyperplasia of the liver,and the combined value of the four is higher.