DWI定量测量鉴别肝结节良恶性

摘要

目的:探讨MR DWI的ADC值鉴别肝脏良恶性结节的价值.方法:回顾性分析术后病理或临床证实肝结节108例156处:良性43例50处,包括肝脏海绵状血管瘤23例27处,肝囊肿20例23处;恶性65例106处,包括肝细胞癌27例32处,肝内胆管细胞癌11例11处,肝转移瘤27例63处.术前行MRI平扫、动态增强扫描及DWI检查比较肝脏良恶性结节ADC值差异.绘制ROC曲线评价诊断效能,依据ROC曲线确定良恶性结节鉴别阈值.比较不同病理类型肝脏恶性结节的ADC值差异.比较不同肝脏良性结节的ADC值差异.结果:肝脏恶性结节ADC值明显低于良性(0.949×10-3mm2/s vs 2.464×10-3 mm2/s),差异有统计学意义(P =0.000 ＜0.05).绘制ROC曲线,曲线下面积为0.996;依据ROC曲线,选取鉴别阈值为1.466×1O-3mm2/s,敏感性、特异性、准确性分别为97.2％、100％及98％.肝脏海绵状血管瘤的ADC值低于肝囊肿,差异有统计学意义(1.842×10-3mm2/s vs 3.195×10-3 mm2/s,P=0.000 ＜0.05).肝细胞癌、肝内胆管细胞癌及肝转移瘤的ADC值差异无统计学意义(P =0.288 ＞0.05).两独立样本秩和检验,肝细胞癌的ADC值低于胆管细胞癌,差异无统计学意义(0.882×10-3mm2/s vs 1.068×10-3mm2/s,P=1.113＞0.05);肝细胞癌的ADC值低于转移瘤(0.962×10-3 mm2/s),差异无统计学意义(P =0.241 ＞0.05);转移瘤的ADC值低于胆管细胞癌,差异无统计学意义(P =0.553 ＞0.05).结论:DWI有助于术前鉴别肝结节的良恶性,ADC值可鉴别肝脏海绵状血管瘤与肝囊肿,但无法区分肝脏恶性结节的病理类型.%Objective:To assess the application of ADC value in the differentiation of benign and malignant liver nodules.Methods:A retrospective analysis was performed for 108 pathologically or clinically confirmed cases with 156 hepatic nodules,among which 43 cases had 50 benign nodules and 65 cases had 106 malignant nodules.The benign nodules included 27 hepatic cavernous hemangiomas (HEM) from 23 cases and 23 hepatic cysts from 20 cases.The malignant nodules included 32 hepatocellular carcinomas (HCC) from 27 cases, 11 intrahepatic cholangiocarcinomas (ICC) in 11 cases, and 63 liver metastasis (MET) from 27 cases.All of patients underwent magnetic resonance (MR) plain scan, dynamic contrast-enhanced MRI (DCE-MRI), and diffusion weighted imaging (DWI).The ADC values between benign and malignant hepatic nodules were compared ROC curve was drawn to determine the diagnostic threshold.To compare the ADC value of hepatic malignant nodules of different pathological types.To compare the ADC value of different benign nodules of liver.Results:The ADC value of hepatic malignant nodules were significantly lower than that of benign nodules (0.949 × 10-3 mm2/s vs 2.464 × 10-3 mm2/s,P =0.000 ＜ 0.05).According to ROC,the diagnostic threshold was 1.466 × 10-3 mm2/s,the sensitivity,specificity and accuracy were 97.2％, 100％ and 98％ respectively.The ADC value of HEM was lower than that of liver cyst (1.842 × 10-3 mm2/s vs 3.195 × 10-3 mm2/s,P =0.000 ＜ 0.05).The ADC values of HCC, ICC and MET were not statistically different (0.882 × 10-3 mm2/s, 1.068 × 10-3 mm2/s and 0.962 × 10-3 mm2/s, P =0.288 ＞ 0.05).Using two independent sample rank test,the ADC value of HCC was lower than that of ICC (P =1.113 ＞0.05),the value of HCC was lower than that of MET (P =0.241 ＞ 0.05), and the value of MET was lower than that of ICC (P =0.553 ＞ 0.05).Conclusion:DWI is helpful in the differential diagnosis of benign and malignant hepatic nodules before operation.The ADC value can distinguish HEM from hepatic cyst,but it can not distinguish the pathological types of hepatic malignant nodules.