磁共振成像多模态参数联合MRI图像纹理参数诊断脂肪肝背景肝脏小结节的价值

摘要/Abstract

摘要： 目的分析磁共振成像(MRI)多模态参数联合MRI图像纹理参数诊断脂肪肝背景肝脏小结节的价值。方法回顾性分析2021年3月至2023年3月在西安高新医院接受治疗的94例脂肪肝背景肝脏小结节患者的病历资料,收集所有患者病理穿刺前或术前的T1WI、抑脂T2WI、MRI-弥散加权成像(DWI)、动态增强成像(DEC)-MRI扫描数据,分析多模态参数及图像纹理特征参数。以病理诊断结果为“金标准”,明确脂肪肝背景下肝脏小结节的良恶性。分析脂肪肝背景肝脏小结节恶性的影响因素,分析MRI-DWI参数、DEC-MRI参数、图像纹理特征参数单一及联合诊断脂肪肝背景肝脏小结节良恶性的灵敏度及特异度。结果 94例脂肪肝背景肝脏小结节患者中,40例患者经病理诊断为恶性结节(+),54例患者经病理诊断为良性结节(-)。在100 s/mm²、500 s/mm²、1 000 s/mm²扩散敏感梯度因子(b值)条件下,恶性结节组患者的表观扩散系数(ADC)分别为(1.99±0.51)×10^-3 mm²/s、(1.87±0.54)×10^-3 mm²/s、(1.65±0.49)×10^-3 mm²/s,低于良性结节组[(2.40±0.68)×10^-3 mm²/s、(2.23±0.57)×10^-3 mm²/s、(2.09±0.53)×10^-3 mm²/s,(P<0.05)]。恶性结节组患者的最大上升斜率(MSI)、最大下降斜率(MSD)及峰值(PV)分别为(301.08±59.06)、(92.63±24.08)、(512.36±72.19),低于良性结节组[(369.16±58.14)、(106.35±27.41)、(581.34±80.27),(P<0.05)]。恶性结节组患者的S(5,5)Sum Varnc/×10²、S(3,3)Sum Varnc/×10²、S(2,3)Sum Varnc/×10²、S(0,1)Sum Varnc/×10²高于良性结节组(P<0.05)。ADC值(b=1 000 s/mm²时,OR=0.282,95%CI:0.104～0.763)、MSI(OR=0.271,95%CI:0.100～0.735)、MSD(OR=0.265,95%CI:0.098～0.717)、PV(OR=0.318,95%CI:0.117～0.860)、S(5,5)Sum Varnc/×10²(OR=3.823,95%CI:1.411～10.356)是脂肪肝背景肝脏小结节恶性的影响因素(P<0.05)。MRI-DWI参数、DEC-MRI参数、图像纹理特征参数单一及联合诊断脂肪肝背景肝脏小结节良恶性的灵敏度分别为0.624、0.697、0.683、0.731,特异度分别为0.713、0.772、0.659、0.800,曲线下面积分别为0.720、0.751、0.713、0.832。结论 MRI多模态参数联合MRI图像纹理参数诊断脂肪肝背景肝脏小结节的效能良好,可用于辅助诊断脂肪肝背景肝脏小结节的良恶性。

关键词: 脂肪肝, 小结节, 磁共振成像, 弥散加权成像, 动态增强成像, 图像纹理参数

Abstract: Objective To analyze the value of magnetic resonance imaging (MRI) multimodal parameters combined with MRI image texture parameters in diagnosing small liver nodules in the background of fatty liver. Methods A retrospective analysis was performed on medical records of 94 patients with fatty liver background liver nodules treated at Xi'an High tech Hospital from March 2021 to March 2023. T1WI, liposuppression T2WI, MRI diffusion-weighted imaging (DWI), dynamic enhanced imaging (DEC)-MRI scan data were collected from all patients before pathological puncture or surgery. Multimodal parameters and image texture feature parameters were analyzed. Using pathological diagnosis as the gold standard, determine the benign or malignant nature of liver nodules in the background of fatty liver. Analyze the influencing factors for malignancy of liver nodules in the context of fatty liver, and analyze the sensitivity and specificity of MRI-DWI parameters, DEC-MRI parameters, and image texture feature parameters for the single or combined diagnosis of benign or malignant liver nodules in fatty liver. Results Among 94 patients with background liver nodules in fatty liver, 40 patients were diagnosed as malignant nodules (+) and 54 patients were diagnosed as benign nodules (-) by pathology. Under diffusion sensitive gradient factor (b value) conditions of 100 s/mm², 500 s/mm², and 1 000 s/mm², the apparent diffusion coefficient (ADC) of the malignant nodule group was (1.99±0.51)×10^-3 mm²/s, (1.87±0.54)×10^-3 mm²/s, and (1.65±0.49)×10^-3 mm²/s, respectively, which were lower than those of the benign nodule group [(2.40±0.68)×10^-3 mm²/s, (2.23±0.57)×10^-3 mm²/s, and (2.09±0.53)×10^-3 mm²/s, (P<0.05)]. The maximum slope increase (MSI), maximum slope decrease (MSD), and peak value (PV) of the malignant nodule group were (301.08±59.06), (92.63±24.08), and (512.36±72.19), respectively, which were lower than those of the benign nodule group [(369.16±58.14), (106.35±27.41), and (581.34±80.27), (P<0.05)]. The S(5,5) Sum Varnc/×10², S(3,3) Sum Varnc/×10², S(2,3) Sum Varnc/×10², and S(0,1) Sum Varnc/×10² of the malignant nodule group were higher than those of the benign nodule group (P<0.05). ADC value (b=1 000 s/mm², OR=0.282, 95%CI: 0.104~0.763), MSI (OR=0.271, 95%CI: 0.100~0.735), MSD (OR=0.265, 95%CI: 0.098~0.717), PV (OR=0.318, 95%CI: 0.117~0.860), S(5,5) Sum Varnc/×10² (OR=3.823, 95%CI: 1.411~10.356) were identified as influencing factors for malignancy of liver nodules in the background of fatty liver (P<0.05). The sensitivity of MRI-DWI parameters, DEC-MRI parameters, and image texture feature parameters for single and combined diagnosis of benign or malignant liver nodules in fatty liver were 0.624, 0.697, 0.683, and 0.731, respectively, while the specificity was 0.713, 0.772, 0.659, and 0.800, and the area under the curve was 0.720, 0.751, 0.713, and 0.832, respectively. Conclusion The combination of MRI multimodal parameters and MRI image texture parameters has a high accuracy in diagnosing small liver nodules in the background of fatty liver, and could be used to assist in the diagnosis of benign and malignant liver nodules in the background of fatty liver.

Key words: Fatty liver, Small nodules, Magnetic resonance imaging, Diffusion weighted imaging, Dynamic enhanced imaging, Image texture parameters

张伟, 问雷涛, 刘文倩. 磁共振成像多模态参数联合MRI图像纹理参数诊断脂肪肝背景肝脏小结节的价值[J]. 肝脏, 2025, 30(9): 1244-1248.

ZHANG Wei, WEN Lei-tao, LIU Wen-qian. The combination of MRI multi-modal parameters and MRI texture parameters has value in the diagnosis of background liver nodules in fatty liver[J]. Chinese Hepatolgy, 2025, 30(9): 1244-1248.

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