磁共振联合双源CT三期增强扫描对肝血管瘤与肝细胞癌的鉴别诊断价值

摘要/Abstract

摘要： 目的探讨磁共振(MRI)联合双源CT三期增强扫描对肝血管瘤(HHE)与肝细胞癌(HCC)的鉴别诊断价值。方法选择2020年4月—2022年11月南京医科大学附属淮安第一医院收治的42例HHE患者(共51个病灶)与60例HCC患者(共65个病灶)为研究对象。所有患者均接受MRI、双源CT三期增强扫描,比较HHE与HCC患者病灶CT平扫影像学资料,以病理诊断为金标准,分析MRI、双源CT三期增强扫描及二者联合与病理诊断的一致性,绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评估MRI、双源CT三期增强扫描及二者联合对HEE与HCC的鉴别诊断价值。结果 MRI检测结果:42例HHE患者检测出46个病灶,病灶检出率为90.20%,60例HCC患者检测出60个病灶,病灶检出率为92.31%。双源CT三期增强扫描检测结果:42例HHE患者检测出41个病灶,病灶检出率为80.39%,60例HCC患者检测出54个病灶,病灶检出率为83.08%。HCC患者病灶圆形、边界模糊、单发病灶高于HHE患者病灶(P<0.05),HHE与HCC患者病灶密度比较差异无统计学意义(P>0.05)。MRI对HEE与HCC鉴别结果与病理诊断的总符合率为91.38%,经Kappa一致性检验,Kappa=0.821,P<0.05,MRI与病理诊断对HHE与HCC鉴别具有良好的一致性;双源CT三期增强扫描对HEE与HCC鉴别结果与病理诊断的总符合率为81.90%,经Kappa一致性检验,Kappa=0.714,P<0.05,双源CT三期增强扫描与病理诊断对HHE与HCC鉴别具有一般的一致性;联合检查对HEE与HCC鉴别结果与病理诊断的总符合率为96.55%,经Kappa一致性检验,Kappa=0.895,P<0.05,联合检查与病理诊断对HHE与HCC鉴别具有良好的一致性。ROC曲线结果显示,MRI、双源CT三期增强扫描及二者联合鉴别诊断HEE与HCC的AUC值分别为0.913、0.817、0.965(P<0.05),MRI鉴别诊断的AUC值高于双源CT三期增强扫描鉴别诊断的AUC值(P<0.05),二者联合鉴别诊断的AUC值高于单独检查方法鉴别诊断的AUC值(P<0.05)。结论 MRI、双源CT三期增强扫描在鉴别诊断HHE与HCC中具有重要价值,且二者联合具有更高的鉴别诊断价值。

关键词: 磁共振, 双源CT三期增强扫描, 肝血管瘤, 肝细胞癌, 鉴别诊断价值

Abstract: Objective To investigate the value of magnetic resonance imaging (MRI) combined with dual-source CT three-phase enhanced scanning in the differential diagnosis of hepatic hemangioma (HHE) and hepatocellular carcinoma (HCC). Methods 42 patients with HHE (51 lesions in total) and 60 patients with HCC (65 lesions in total) admitted to the hospital from April 2020 to November 2022 were selected as subjects. All patients underwent MRI and dual-source CT three-phase enhanced scanning. The imaging data of lesions obtained from plain CT scan were compared between patients with HHE and HCC. The gold standard for analysis was pathological diagnosis, which was used to assess the consistency of MRI, dual-source CT three-phase enhanced scanning and their combination with pathological diagnosis. Receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was used to evaluate the diagnosis value of MRI, dual-source CT and their combination in distinguishing between HEE and HCC. Results MRI detection results: 46 lesions were detected in 42 HHE patients, with a detection rate of 90.20%; 60 lesions were detected in 60 HCC patients, with a detection rate of 92.31%. Results of dual-source CT three-phase enhanced scanning: 41 lesions were detected in 42 patients with HHE, with a detection rate of 80.39%; 54 lesions were detected in 60 patients with HCC, with a detection rate of 83.08%. The number of circular lesions, the degree of border indistinctness, and the number of single lesions in HCC patients were higher than those in HHE patients (P<0.05). There was no significant difference in lesion density between HHE and HCC patients (P>0.05).The total coincidence rate of MRI in distinguishing HEE from HCC compared to pathological diagnosis was 91.38%. The Kappa consistency test indicated that there was a good consistency (Kappa=0.821, P<0.05) between MRI and pathological diagnosis in identifying HHE and HCC. The total coincidence rate of three-phase dual-source CT scanning in distinguishing HEE from HCC was 81.90%. The Kappa consistency test, indicated that there was a general consistency (Kappa=0.714, P<0.05) between dual-source CT three-phase enhanced scanning and pathological diagnosis in identifying HHE and HCC. The total coincidence rate of the combined examination in distinguishing HEE from HCC was 96.55%. The Kappa consistency test indicated that there was a good consistency (Kappa=0.895, P<0.05) between the combined examination and pathological diagnosis in identifying HHE and HCC. ROC curve results showed that the AUC values of MRI, dual-source CT three-phase enhanced scanning and the combined diagnosis of HEE and HCC were 0.913, 0.817 and 0.965, respectively (P<0.05), and the AUC value of MRI was higher than that of dual-source CT three-phase enhanced scanning (P<0.05). The AUC value of combined diagnosis was higher than that of single diagnosis (P<0.05). Conclusion MRI and dual-source CT are valuable tools for distinguishing between HHE and HCC, and their combination has a higher value in the differential diagnosis.

Key words: Magnetic resonance, Dual-source CT three-stage enhanced scanning, Hepatic hemangioma, Hepatocellular carcinoma, Differential diagnostic value

韩雪凤, 井桂银, 葛尚. 磁共振联合双源CT三期增强扫描对肝血管瘤与肝细胞癌的鉴别诊断价值[J]. 肝脏, 2023, 28(10): 1199-1203.

HAN Xue-feng, JING Gui-yin, GE Shang. Value of magnetic resonance combined with dual-source CT in the differential diagnosis of hepatic hemangioma and hepatocellular carcinoma[J]. Chinese Hepatolgy, 2023, 28(10): 1199-1203.

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