多模态MRI征象诊断脂肪肝合并局灶性结节性病变的效能

摘要/Abstract

摘要： 目的比较局灶性结节性增生(FNH)、肝细胞癌(HCC)在MRI质子密度脂肪分数(PDFF)、弥散参数及动态增强灌注特征方面的差异,并探讨其诊断效能。方法收集2022年12月至2025年9月周口市中医院接受肝脏MRI检查并经病理证实为脂肪肝合并局灶性结节性病变患者92例,其中FNH 55例、HCC 37例。比较FNH、HCC两组脂肪定量参数、弥散参数及动态增强参数,并分析诊断效能。结果 FNH组病灶内及病灶周围肝实质PDFF为(9.3±2.1)%和(18.6±6.2)%,显著低于HCC组的(16.7±2.9)%和(24.9±7.8)%(均P<0.05)。FNH组表观弥散系数(ADC)及纯扩散系数D均显著高于HCC组,为(1.45±0.18)×10^-3 mm²/s比(1.12±0.21)×10^-3 mm²/s、(1.18±0.14)比(0.89±0.16),均P<0.05;而微灌注分数f显著低于HCC组,为(18.2±4.1)% 比(25.7±5.4)%(P<0.05)。FNH组动脉期增强幅度显著低于HCC组,为(78.6±22.4)%比 (112.3±28.5)%(P<0.05),而门静脉期与延迟期相对强化比更高,为(0.92±0.15)比 (0.68±0.14)、(0.88±0.13)比(0.56±0.12)(均P<0.05)。ROC分析显示ADC、延迟期强化比、洗脱率及强化模式的AUC分别为0.90、0.91、0.93及0.94,多参数联合模型AUC达0.97,灵敏度94.5%,特异度91.9%。结论多模态MRI能够从脂肪沉积、组织结构、细胞密度和血流灌注多层面有效区分脂肪肝背景下的FNH与HCC,其综合诊断效能显著高于单一参数。

关键词: 脂肪肝, 局灶性结节性增生, 肝细胞癌, 质子密度脂肪分数

Abstract: Objective To compare the differences between focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC) in terms of MRI proton density fat fraction (PDFF), diffusion parameters, and dynamic contrast-enhanced perfusion characteristics, and to evaluate their diagnostic performance. Methods A total of 92 patients who underwent liver MRI between December 2022 and September 2025 and were pathologically confirmed to have fatty liver with focal nodular lesions were retrospectively enrolled. According to pathological diagnosis, 55 cases were classified as FNH and 37 cases as HCC. Fat quantification parameters, diffusion parameters, and dynamic enhancement characteristics were compared between the two groups, and their diagnostic performance was evaluated. Results In FNH group, the PDFF in the lesion and the surrounding liver parenchyma were significantly lower than those in HCC group [(9.3±2.1)% vs. (16.7±2.9)%, (18.6±6.2)% vs. (24.9±7.8)%, all P<0.05). In terms of diffusion parameters, ADC and pure diffusion coefficient D in FNH group were significantly higher than those in HCC group [(1.45±0.18) × 10^-3 mm²/s vs. (1.12±0.21) × 10^-3 m²/s; (1.18±0.14) vs. (0.89±0.16), all P<0.05), while the micro-perfusion fraction F was significantly lower than that in HCC group [(18.2±4.1)% vs. (25.7±5.4)%, P<0.05). In the aspect of dynamic enhancement, the enhancement amplitude of FNH group in arterial phase was significantly lower than that of HCC group [(78.6±22.4)% vs. (112.3±28.5)%, P<0.05], while the relative enhancement ratio of portal vein phase and delayed phase was higher [(0.92±0.15) vs. (0.68±0.14), (0.88±0.13) vs. (0.56±0.12), all P<0.05]. ROC analysis showed that the AUC of ADC, enhancement ratio of delay period, elution rate and enhancement mode were 0.90, 0.91, 0.93 and 0.94, respectively, and the AUC of multi-parameter joint model reached 0.97, with sensitivity of 94.5% and specificity of 91.9%. Conclusion Multimodal MRI can effectively distinguish FNH from HCC in the background of fatty liver by assessing fat deposition, tissue structure, cellular density, and perfusion characteristics. Its comprehensive diagnostic performance is significantly superior to any single sequence or parameter.

Key words: Fatty liver, Focal nodular hyperplasia, Hepatocellular carcinoma, Proton density fat fraction

张合意, 理欣然, 刘肖肖. 多模态MRI征象诊断脂肪肝合并局灶性结节性病变的效能[J]. 肝脏, 2026, 31(4): 528-531.

ZHANG He-yi, LI Xin-ran, LIU Xiao-xiao. Study on the application of multimodal MRI findings in the diagnosis of fatty liver with focal nodular lesions[J]. Chinese Hepatolgy, 2026, 31(4): 528-531.

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参考文献

[1] Fromenty B, Roden M. Mitochondrial alterations in fatty liver diseases[J]. J Hepatol, 2023, 78(2):415-429.
[2] Hu Y, Hu X, Jiang L, et al. Microbiome and metabolomics reveal the effect of gut microbiota on liver regeneration of fatty liver disease[J]. EBioMedicine, 2025, 111:105482.
[3] Lou T W, Yang R X, Fan J G. The global burden of fatty liver disease: the major impact of China[J]. Hepatobiliary Surg Nutr, 2024, 13(1):119-123.
[4] Rinella M E, Lazarus J V, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature[J]. Ann Hepatol, 2024, 29(1):101133.
[5] Huang Z, Lin X J, Li S S, et al. Differentiating atypical hepatocellular carcinoma from focal nodular hyperplasia: the value of Kupffer phase imaging with sonazoid-contrast-enhanced ultrasound compared to gadodiamide-enhanced MRI[J]. Eur J Radiol, 2025, 184:111991.
[6] Ding Z, Lin K, Fu J, et al. An MR-based radiomics model for differentiation between hepatocellular carcinoma and focal nodular hyperplasia in non-cirrhotic liver[J]. World J Surg Oncol, 2021, 19(1):181.
[7] Le Gout J D, Bolan C W, Bowman A W, et al. Focal nodular hyperplasia and focal nodular hyperplasia-like lesions[J]. Radiographics, 2022, 42(4):1043-1061.
[8] Feng F, Zhao Y. Hepatocellular carcinoma: prevention, diagnosis, and treatment[J]. Med Princ Pract, 2024, 33(5):414-423.
[9] Xia T, Du M, Li H, et al. Association between liver MRI proton density fat fraction and liver disease risk[J]. Radiology, 2023, 309(1):e231007.
[10] Reeder S B, Starekova J. MRI proton density fat fraction for liver disease risk assessment: a call for clinical implementation[J]. Radiology, 2023, 309(1):e232552.
[11] Liang W, Shao J, Liu W, et al. Differentiating hepatic epithelioid angiomyolipoma from hepatocellular carcinoma and focal nodular hyperplasia via radiomics models[J]. Front Oncol, 2020, 10:564307.
[12] 中国研究型医院学会肝病专业委员会, 中国医师协会脂肪性肝病专家委员会, 中华医学会肝病学分会脂肪肝与酒精性肝病学组, 中华医学会内分泌学分会肝病与代谢学组. 脂肪性肝病诊疗规范化的专家建议(2019年修订版)[J]. 实用肝脏病杂志, 2019, 22(6):787-792.
[13] Li W, Li R, Zhao X, et al. Differentiation of hepatocellular carcinoma from hepatic hemangioma and focal nodular hyperplasia using computed tomographic spectral imaging[J]. J Clin Transl Hepatol, 2021, 9(3):315-323.
[14] Yu Y, Lin X, Chen K, et al. Hepatocellular carcinoma and focal nodular hyperplasia of the liver: differentiation with CT spectral imaging[J]. Eur Radiol, 2013, 23(6):1660-1668.
[15] Gatti M, Calandri M, Bergamasco L, et al. Characterization of the arterial enhancement pattern of focal liver lesions by multiple arterial phase magnetic resonance imaging: comparison between hepatocellular carcinoma and focal nodular hyperplasia[J]. Radiol Med, 2020, 125(4):348-355.
[16] Kitao A, Matsui O, Yoneda N, et al. Differentiation between hepatocellular carcinoma showing hyperintensity on the hepatobiliary phase of gadoxetic acid-enhanced MRI and focal nodular hyperplasia by CT and MRI[J]. AJR Am J Roentgenol, 2018, 211(2):347-357.
[17] 郎也, 马春琼, 邓礼巍, 等. 利用磁共振成像多模态参数鉴别肝胆期高信号的肝细胞癌与局灶性结节增生[J]. 中华肝脏病杂志, 2022, 30(10):1069-1073.
[18] 伏林, 张龄尹, 魏倩. MRI在脂肪肝背景下对局灶性结节性病变定性诊断价值分析[J]. 实用肝脏病杂志, 2025, 28(1):140-143.
[19] 李明通. 肝脏局灶性结节性增生和甲胎蛋白阴性肝细胞癌患者的影像学特点分析[J]. 临床肝胆病杂志, 2015(5):729-732.
[20] Mao H Y, Shen B Q, Zhang J Y, et al. Gd-EOB-DTPA enhanced MRI nomogram model to differentiate hepatocellular carcinoma and focal nodular hyperplasia both showing iso- or hyperintensity in the hepatobiliary phase[J]. BMC Med Imaging, 2024, 24(1):211.