MRI多模态参数联合超声造影对肝细胞癌和肝局灶性结节增生的鉴别诊断价值

摘要/Abstract

摘要： 目的探讨磁共振成像(MRI)多模态参数联合超声造影在鉴别肝细胞癌(HCC)与肝局灶性结节增生(FNH)中的应用价值。方法收集2019年1月至2024年3月本院收治的33例HCC患者和30例FNH患者的临床资料,所有患者均行增强MRI检查和超声造影,术后标本行病理学检查和免疫组织化学检测。由两名放射科医师分析HCC与FNH的影像学特征及超声造影参数。结果多模态MRI方面,HCC组30例(90.91%)为持续性强化,3例(9.09%)为快进快出;FNH组30例(100.00%)为持续性强化,0例(0.00%)为快进快出,差异无统计学意义(P>0.05)。在SI_增强率上,HCC组为(1.37±0.58),FNH组为(1.31±0.51),差异无统计学意义(P>0.05)。在SI_ADC上,HCC组为(0.91±0.17)显著低于FNH组的(1.19±0.18)(P<0.05)。肝胆期特征方面,HCC组瘤周低信号环为17例(51.52%),FNH组为0例(0.00%),差异具有统计学意义(P<0.001);HCC组对比剂充盈缺损17例(51.52%),FNH组为0例(0.00%),差异具有统计学意义(P<0.001)。HCC组线状低信号分隔为22例(66.67%),FNH组为1例(3.33%),差异具有统计学意义(P<0.001);HCC组中央星状瘢痕为0例(0.00%),FNH组为9例(30.00%),差异具有统计学意义(P<0.001)。HCC组的ADC值为(1233.21±249.27)10^-3 mm²/s,显著低于FNH组的(1451.49±231.50)10^-3 mm²/s,差异具有统计学意义(P<0.001)。超声检查中,HCC组的RT为(2.49±1.22)s,显著低于FNH组(3.58±1.71)s,差异具有统计学意义(P=0.005);HCC组的TTP为(33.59±9.45)s,显著高于FNH组的(25.39±8.10)s,差异具有统计学意义(P<0.001);HCC组的MTT为(35.20±5.07)s,显著高于FNH组的(32.05±5.45)s,差异具有统计学意义(P=0.021);HCC组的PI为(28.58±6.70)dB,显著高于FNH组(22.82±5.98)dB,差异具有统计学意义(P<0.001)。MRI多模态参数、超声造影以及两者联合应用在诊断中的效果对比显示,MRI多模态参数的灵敏度为87.9%,特异度为93.3%,约登指数为0.812,AUC面积为0.917;超声造影的灵敏度为69.7%,特异度为93.3%,约登指数为0.630,AUC面积为0.843;联合应用的灵敏度提升至90.9%,特异度提升至96.7%,约登指数为0.876,AUC面积达到0.961,表明联合检测具有更高的诊断效能。结论 MRI多模态参数联合超声造影在鉴别HCC与FNH中具有重要的临床应用价值,均具有较高的灵敏度和特异度,值得临床推广应用。

关键词: 肝细胞癌, 肝局灶性结节增生, 磁共振成像, 超声造影, 鉴别诊断

Abstract: Objective To investigate the diagnostic value of combined MRI multimodal parameters and contrast-enhanced ultrasound (CEUS) in differentiating hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH). Methods Clinical data of 33 HCC patients and 30 FNH patients treated in our hospital from January 2019 to March 2024 was collected. All patients underwent enhanced MRI and CEUS, with postoperative pathological and immunohistochemical examinations. Two radiologists analyzed the imaging features and CEUS parameters of HCC and FNH. Quantitative data was compared using t-tests, and categorical data was compared using χ² tests. Results In multimodal MRI, 30 cases (90.91%) of the HCC group showed persistent enhancement, while 3 cases (9.09%) exhibited rapid wash-in and wash-out; all 30 cases (100.00%) in the FNH group showed persistent enhancement, with no rapid wash-in and wash-out (0.00%), and the difference was not statistically significant (P>0.05). The enhancement rate of signal intensity was (1.37±0.58) in the HCC group and (1.31±0.51) in the FNH group, with no statistically significant difference (P>0.05). The apparent diffusion coefficient of SI (SI_ADC) was (0.91±0.17) in the HCC group, significantly lower than (1.19±0.18) in the FNH group (P<0.05). In the hepatobiliary phase characteristics, 17 cases (51.52%) in the HCC group showed a peritumoral low-signal ring, while none (0.00%) was observed in the FNH group, with a significant difference (P<0.001); 17 cases (51.52%) in the HCC group showed contrast filling defects, while none (0.00%) was observed in the FNH group, with a significant difference (P<0.001). There were 22 cases (66.67%) in the HCC group with linear low-signal septa, compared to 1 case (3.33%) in the FNH group, showing a significant difference (P<0.001); no central stellate scar (0.00%) was observed in the HCC group, while it was present in 9 cases (30.00%) in the FNH group, with a significant difference (P<0.001). The ADC value in the HCC group was (1233.21±249.27)×10^-3 mm²/s, significantly lower than (1451.49±231.50)×10^-3 mm²/s in the FNH group (P<0.001). In ultrasound examinations, the rise time (RT) in the HCC group was (2.49±1.22) s, significantly lower than (3.58±1.71) s in the FNH group (P=0.005); the time to peak (TTP) in the HCC group was (33.59±9.45) s, significantly higher than (25.39±8.10) s in the FNH group (P<0.001); the mean transit time (MTT) in the HCC group was (35.20±5.07) s, significantly higher than (32.05±5.45) s in the FNH group (P=0.021); and the perfusion intensity (PI) in the HCC group was (28.58±6.70) dB, significantly higher than (22.82±5.98) dB in the FNH group (P<0.001). Comparison of diagnostic performance showed that the sensitivity, specificity, Youden index, and AUC for MRI multimodal parameters were 87.9%, 93.3%, 0.812, and 0.917, respectively, for CEUS, these values were 69.7%, 93.3%, 0.630, and 0.843, respectively. Combined application improved sensitivity to 90.9%, specificity to 96.7%, Youden index to 0.876, and AUC to 0.961, indicating a higher diagnostic efficiency. Conclusion The combined application of MRI multimodal parameters and CEUS has significant clinical value in differentiating HCC from FNH, with high sensitivity and specificity, and is worthy of clinical promotion.

Key words: Hepatocellular carcinoma, Focal nodular hyperplasia, Magnetic resonance imaging, Contrast-enhanced ultrasound, Differential diagnosis

李荣江, 张海荣, 魏亚娟, 何鑫, 李劲松. MRI多模态参数联合超声造影对肝细胞癌和肝局灶性结节增生的鉴别诊断价值[J]. 肝脏, 2025, 30(10): 1360-1364.

LI Rong-jiang, ZHANG Hai-rong, WEI Ya-juan, HE Xin, LI Jin-song. Diagnostic value of combined MRI multimodal parameters and contrast-enhanced ultrasound for differentiating hepatocellular carcinoma and focal nodular hyperplasia[J]. Chinese Hepatolgy, 2025, 30(10): 1360-1364.

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