T2WI序列图像TA在肝硬化背景下结节及小肝癌鉴别诊断中的应用

摘要/Abstract

摘要： 目的研究T2加权图像(T2WI)序列图像纹理分析(TA)在肝硬化背景下增生结节(DNs)及小肝癌(sHCC)鉴别诊断中的应用价值。方法回顾性分析2016年1月至2020年11月收治的有完整术前常规MRI资料并经手术病理证实的单发肝硬化结节(直径≤3 cm)患者76例的临床资料,其中sHCC患者48例(设为sHCC组),DNs患者28例(设为DNs组)。两组均于手术病理学诊断前1周接受常规磁共振成像(MRI)检查,均行常规T2WI序列TA分析。选取结节最大层面轴位T2WI图像,利用Image J软件行病灶感兴趣区(ROI)手动勾画,提取灰度共生矩阵和直方图纹理参数,包括能量、熵、逆差距、相关性、对比度、平均值、峰度、偏度。对比两组灰度共生矩阵和直方图纹理参数变化情况,并采用受试者工作特性曲线(ROC)评价上述纹理参数对肝硬化背景下DNs与sHCC的鉴别诊断效能。结果 sHCC组能量、相关性分别为(15.50±7.25)×10^-4、(15.35±7.40)×10^-4显著低于DNs组(24.58±12.28)×10^-4、(33.72±14.71)×10^-4(P<0.05),熵(7.00±0.32)显著高于DNs组(6.62±0.63)(P<0.05),逆差距、对比度、平均值、峰度、偏度较DNs组无显著差异(P>0.05)。经ROC分析,能量、熵、相关性对肝硬化背景下DNs与sHCC均有一定鉴别诊断效能,曲线下面积分别为0.693、0.648、0.831。结论常规T2WI序列TA下灰度共生矩阵和直方图纹理参数能量、熵、相关性鉴别诊断肝硬化背景下DNs与sHCC的效能较高,建议临床推广应用。

关键词: 磁共振成像, 纹理分析, 肝硬化, 增生结节, 小肝癌

Abstract: Objective To study on the application value of T2 weighted image (T2WI) sequence texture analysis (TA) in the differential diagnosis of proliferative nodules (DNs) and small hepatocellular carcinoma (sHCC) under the background of liver cirrhosis. Methods The clinical data of 76 patients admitted from January 2016 to November 2020 who had single cirrhotic nodule (diameter≤3 cm) confirmed by surgery and pathology were retrospectively analyzed. Within them 48 patients were diagnosed as sHCC (sHCC group) and 28 patients were diagnosed as DNs (DNs group). All patients received operation and obtained pathological diagnosis. Routine magnetic resonance imaging (MRI) examinations were performed in both groups of patients at 1 week before operation. Routine T₂WI sequence-TA analysis was performed. The axial T₂WI image of the largest section of the nodule was selected, and the region of interest (ROI) was manually outlined by Image J software. The gray level co-occurrence matrix and histogram texture parameters were extracted, including energy, entropy, inverse gap, correlation, contrast, average, kurtosis and skewness. The gray level co-occurrence matrix and histogram texture parameters of the two groups were compared, and the receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of the above texture parameters for the differential diagnosis of DNs and sHCC under the background of liver cirrhosis. Results In SHCC group, the energy and the correlation were (15.50± 7.25)×10^-4 and (15.35 ±7.40)×10^-4, respectively, which was significantly lower than those of (24. 58± 12.28)×10^-4 and (33.72 ± 14.71)×10^-4 in DNS group (P<0.05). The Entropy in SHCC group was (7. 00 ± 0.32), which was significantly higher than (6. 62 ± 0.63)in DNS group(P<0.05). The inverse difference, contrast, average, kurtosis and skewness of sHCC group had no significant difference compared with those of DNs group (P>0.05). ROC analysis showed that energy, entropy and correlation had a certain differential diagnosis efficacy on DNs and sHCC on the background of liver cirrhosis, and the area under the curve was 0.693, 0.648 and 0.831, respectively. Conclusion Conventional T₂WI sequence TA gray level co-occurrence matrix and histogram texture parameters energy, entropy, correlation have high efficacies in the differential diagnosis of DNs and sHCC under the background of liver cirrhosis, thus are recommended for clinical application.

Key words: Magnetic resonance imaging, Texture analysis, Liver cirrhosis, Proliferative nodules, Small hepatocellular carcinoma

冯权烨, 耿承军, 殷慧康. T2WI序列图像TA在肝硬化背景下结节及小肝癌鉴别诊断中的应用[J]. 肝脏, 2022, 27(2): 193-195.

FENG Quan-ye, GENG Cheng-jun, YIN Hui-kang. Application of T2WI sequence image TA in the differential diagnosis of nodules and small hepatocellular carcinoma under the background of liver cirrhosis[J]. Chinese Hepatolgy, 2022, 27(2): 193-195.

参考文献

[1] 吴东波, 唐红. 肝硬化与肝癌癌前病变的研究进展. 中华肝脏病杂志, 2019, 27:483-486.
[2] 曹怡, 方向军, 代月黎. 普美显MRI增强扫描鉴别肝硬化结节与肝癌应用价值. 中南医学科学杂志, 2020, 48:76-79.
[3] Crimì F, Capelli G, Spolverato G, et al. MRI T2-weighted sequences-based texture analysis (TA) as a predictor of response to neoadjuvant chemo-radiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). Radiol Med, 2020, 125:1216-1224.
[4] Thomas JV, Abou Elkassem AM, Ganeshan B, et al. MR imaging texture analysis in the abdomen and pelvis. Magn Reson Imaging Clin N Am, 2020, 28:447-456.
[5] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年版). 中华实验和临床感染病杂志(电子版),2015, 9:570-589.
[6] 夏锋, 张大志. 不典型增生结节与肝癌癌前病变. 中华肝脏病杂志, 2019, 27:481-482.
[7] Kim MJ, Lee S, An C. Problematic lesions in cirrhotic liver mimicking hepatocellular carcinoma. Eur Radiol, 2019, 29:5101-5110.
[8] 杨健, 柏玉涵, 时昭红,等. Gd-EOB-DTPA多模态MRI对常规MRI不典型强化肝硬化结节的诊断价值. 中国医学影像学杂志, 2019, 27:695-699.
[9] Ta D, Khan M, Ishaque A, et al. Reliability of 3D texture analysis: A multicenter MRI study of the brain. J Magn Reson Imaging, 2020, 51:1200-1209.
[10] Sarioglu FC, Sarioglu O, Guleryuz H, et al. MRI-based texture analysis for differentiating pediatric craniofacial rhabdomyosarcoma from infantile hemangioma. Eur Radiol, 2020, 30:5227-5236.
[11] Shu Z, Fang S, Ye Q, et al. Prediction of efficacy of neoadjuvant chemoradiotherapy for rectal cancer: the value of texture analysis of magnetic resonance images. Abdom Radiol (NY), 2019, 44:3775-3784.
[12] 钟熹, 李建生, 陈志军, 等. MR扩散加权成像纹理分析鉴别肝硬化背景下不典型强化的小肝癌和增生结节. 中华肝脏病杂志, 2020, 28:37-42.
[13] Wang BT, Fan WP, Xu H, et al. Value of magnetic resonance imaging texture analysis in the differential diagnosis of benign and malignant breast tumors. Chin Med Sci J, 2019, 34:33-37.
[14] 李昌, 段祥攻. MRI纹理分析鉴别诊断肝硬化背景下肝脏占位性病变性质的价值. 现代消化及介入诊疗, 2020, 25:388-391.
[15] 李鹏, 郭仲杰, 杨旭, 等. MRI图像纹理定量分析肝硬化再生结节与小肝癌的应用价值. 肝脏, 2020, 25:721-723.
[16] 张衡, 张慧慧, 舒政, 等. MRI T2WI图像纹理分析预测甲状腺乳头状癌颈部淋巴结转移的诊断价值. 中国临床医学影像杂志, 2020, 31:568-571.
[17] Zhong X, Tang H, Lu B, et al. Differentiation of small hepatocellular carcinoma from dysplastic nodules in cirrhotic liver: texture analysis based on MRI improved performance in comparison over gadoxetic acid-enhanced mr and diffusion-weighted imaging. Front Oncol, 2020, 9:1382-1390.