磁共振磁敏感加权成像联合扩散加权成像序列在肝脏局灶性病变诊断中的应用价值

摘要

Objective To investigate the application value of MR SWI and DWI in the diagnosis of liver lesions.Methods 1 300 patients underwent 1.5T MRI scan of liver,no pathology or follow-up examination results of patients with focal liver lesions were excluded,147 patients were included and underwent conventional magnetic resonance(MRI),DWI and SWI.By 2 senior radiologists with double blind method of conventional MRI and MRI combined with DWI and SWI image reading,the feature and enhancement pattern of signal intensity were evaluated.Kappa test was used to evaluate the consistency of the diagnosis of 2 physicians.The pathological examination and comprehensive follow-up results were used as the gold standard.The diagnostic accuracy of the two groups was compared.Results 2 doctors had good consistency in the image diagnosis of the two groups.The Kappa values of conventional MRI and conventional MRI combined with DWI and SWI images were 0.912 and 0.936,respectively.The conventional MRI diagnosed primary hepatocellular carcinoma(HCC) in 40 cases,bile duct cancer cells (ICC) in 13 cases,liver metastasis (HMs) in 14 cases,cavernous hemangioma of the liver (CHL) in 17 cases.The conventional MRI combined with DWI and SWI diagnosed HCC in 50 cases,ICC in 20 cases,HMs in 20 cases,CHL in 24 cases,the differences were statistically significant (x2 =5.660,5.250,5.560,6.640,all P ＜ 0.05).Conclusion Conventional MRI combined with DWI and SWI can provide additional valuable information and improve diagnostic performance for liver lesions.%目的 探讨磁共振磁敏感加权成像(SWI)联合扩散加权成像(DWI)序列在肝脏局灶性病变诊断中的应用价值.方法 选取行1.5T磁共振(MRI)肝脏扫描者1 300例,排除非肝脏局灶性病变、无病理或综合随访检查结果者,最终纳入研究患者147例,患者均行常规MRI、DWI和SWI检查.由2名高年资放射科医师采用双盲法对常规MRI、常规MRI联合DWI及SWI图像阅片,评价病灶信号特征及强化方式.采用Kappa检验评价2名医师诊断的一致性,以病理检查和综合随访结果为金标准,比较两种图像诊断的正确性.结果 2名医师对两组图像诊断的一致性较好,常规MRI和常规MRI联合DWI、SWI图像Kappa值分别为0.912、0.936.常规MRI诊断原发性肝癌(HCC)40例、胆管细胞癌(ICC)13例、肝转移瘤(HMs) 14例、肝海绵状血管瘤(CHL) 17例,常规MRI联合DWI及SWI诊断HCC 50例、ICC 20例、HMs 20例、CHL 24例,差异均有统计学意义(x2 =5.660、5.250、5.560、6.640,均P＜0.05).结论 常规MRI联合DWI、SWI可以提高肝脏局灶性病变的诊断效能.