多模态影像定量参数在肝硬化背景下小肝癌及增生结节的鉴别诊断价值

摘要/Abstract

摘要： 目的探讨多模态影像定量参数在肝硬化背景下小肝癌(SHCC)及增生结节的鉴别诊断价值。方法 80例肝硬化合并病灶性占位患者,根据病理诊断分为肝硬化小肝癌46例(SHCC组)与肝硬化增生结节组34例(结节组),对SHCC组及结节组进行术前CT、超声造影(CEUS)及MRI检查,观察两类病灶影像特征,并行定量参数对比研究。结果 CT显示,SHCC组和结节组血流量(BF)分别为(170.37±58.49)和(143.45±55.24)、血容量(BV)分别为(16.51±5.89)和(13.12±4.03)、平均通过时间(MIT)分别为(9.39±2.58)和(8.12±2.37)、表面通透性(PS)分别为(49.30±15.16)和(42.71±13.28)、肝动脉分数(HAF)分别为(59.34±13.70)和(46.35±11.38),差异有统计学意义(t=2.083、2.891、2.252、2.024、4.498,均P<0.05)。CEUS显示,SHCC组和结节组开始增强时间(AT)分别为(15.23±3.64)s和(19.11±3.08)s、达峰时间(TTP)分别为(29.63±9.68)s和(62.37±13.65)s、峰值强度(PI)分别为(65.19±7.64)和(55.29±6.81)差异有统计学意义(t=5.023、12.558、5.996,均P<0.01);动脉期局部血容量(RBV)分别为(3367.5±751.7)和(1458.2±709.8)、动脉期局部血流量(RBF)分别为(64.3±18.9)和(48.2±13.1)、延迟期RBV分别为(473.2±155.1)和(736.5±295.6),差异均有统计学意义(t=11.497、4.264、5.163,均P<0.01)。MRI显示,SHCC组和结节组表观扩散系数(ADC)值分别为(0.78±0.17)×10^-3 mm²/s和(1.35±0.39)×10^-3 mm²/s,纯扩散系数(D)分别为(0.89±0.21)×10^-3 mm²/s和(1.17±0.25)×10^-3 mm²/s,伪扩散系数(D*)分别为(45.14±10.12)×10^-3 mm²/s和(81.56±15.41)×10^-3 mm²/s,差异均有统计学意义(t=8.854、5.435、12.749,均P<0.01)。三种方式联合检查对肝硬化背景下SHCC及增生结节的检出率分别为93.48%、94.12%,均显著高于单一CT、CUES及MRI检查(P<0.05)。结论 CT、CEUS及MRI的定量参数能在一定程度上反映肿瘤病理生理及血流动力学改变,但单一检测对于肝硬化背景下SHCC及增生结节的判断仍存在局限,联合多种影像参数能提高肝硬化背景下SHCC及增生结节的诊断准确性和可靠性。

关键词: 肝硬化, 小肝癌, 增生结节, 超声造影, 磁共振成像, 定量参数, 鉴别诊断

Abstract: Objective To explore the value of multimodal imaging quantitative parameters in the differential diagnosis of small hepatocellular carcinoma (SHCC) and dysplastic nodules (DN) on the background of cirrhosis.Methods Eighty patients with cirrhosis and focal space-occupying lesions were divided into SHCC group (46 cases, SHCC) and nodule group (34 cases, DN) according to their pathological diagnosis. Preoperative CT, contrast-enhanced ultrasound (CEUS) and MRI examinations were conducted in both groups of patients. The imaging characteristics of lesions and quantitative parameters were compared between the two groups of patients.Results As shown by CT, the blood flow (BF) (170.37±58.49 vs 143.45±55.24), blood volume (BV) (16.51±5.89 vs 13.12±4.03), mean transit time (MIT) (9.39±2.58 vs 8.12±2.37), surface permeability (PS) (49.30±15.16 vs 42.71±13.28), and hepatic artery fraction (HAF) (59.34±13.70 vs 46.35±11.38) were different between the SHCC group and the nodule group (all P<0.01). As shown by CEUS, the arrival time (AT) (15.23±3.64s vs 19.11±3.08s), time to peak (TTP) (29.63±9.68s vs 62.37±13.65s), peak intensity (PI) (65.19±7.64 vs 55.29±6.81), regional blood volume (RBV) in arterial phase (3367.5±751.7 vs 1458.2±709.8), regional blood flow (RBF) in arterial phase (64.3±18.9 vs 48.2±13.1), regional blood volume (RBV) in delay phase (473.2±155.1 vs 736.5±295) between the SHCC group and the nodule group were also different (all P<0.01). MRI shown that the apparent diffusion coefficient (ADC) {(0.78±0.17)×10^-3 mm²/s vs 1.35±0.39)×10^-3 mm²/s}, pure diffusion coefficient (D) {(0.89±0.21)×10^-3 mm²/s vs (1.17±0.25)×10^-3 mm²/s}, pseudo diffusion coefficient (D*) {(45.14±10.12)×10^-3 mm²/s vs (81.56±15.41)×10^-3 mm²/s} were also different between the SHCC group and the nodule group (all P<0.01). The detection rates of SHCC and DN on the background of cirrhosis by CT in combination with CUES or with MRI was 93.48% and 94.12%, respectively, which were significantly higher than those of by themselves alone (P<0.05).Conclusion The quantitative parameters of CT, CEUS and MRI can reflect tumor pathophysiology and hemodynamic changes to certain extents. However, single detection still has limitation to distinct SHCC and DN on the background of cirrhosis. The combinations of multiple imaging parameters improve the diagnostic accuracy and reliability.

Key words: Cirrhosis, Small hepatocellular carcinoma, Dysplastic nodule, Contrast-enhanced ultrasound, Magnetic resonance imaging, Quantitative parameter, Differential diagnosis

王开乐, 金贤德, 王甄, 张欣, 周杰. 多模态影像定量参数在肝硬化背景下小肝癌及增生结节的鉴别诊断价值[J]. 肝脏, 2021, 26(8): 861-865.

WANG Kai-le, JIN Xian-de, WANG Zhen, ZHANG Xin, ZHOU Jie. The value of multimodal imaging quantitative parameters in the differential diagnosis of small hepatocellular carcinoma and dysplastic nodules on the background of cirrhosis[J]. Chinese Hepatolgy, 2021, 26(8): 861-865.

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