DWI序列ADC值联合LAVA在肝脏恶性肿瘤诊断中的应用价值探讨

摘要

目的 探讨多b值扩散加权成像(DWI)序列表观扩散系数(ADC)联合肝脏三维容积快速多期动态增强技术(LAVA)在肝脏恶性肿瘤诊断中的应用价值.方法 本研究纳入80例肝脏占位性病变患者(共124个病灶),其中血管瘤17例(27个病灶)和肝囊肿23例(31个病灶),肝转移癌14例(23个病灶)和肝细胞癌26例(43个病灶).进行T1WI和T2WI常规扫描、DWI(b值分别为0、50、100、150、200、250、300、500、750和1000 s/mm2)和LAVA检查.采用不同方法诊断,A法为T1WI和T2WI常规扫描和DWI诊断,B法为T1WI和T2WI常规扫描和LAVA诊断,C法为T1WI和T2WI常规扫描、DWI联合LAVA诊断,比较三种方法的诊断率.结果 31个(72.1%)肝细胞癌病灶表现为"快进快出"式强化,19个(82.6%)转移瘤病灶表现为边缘环形强化,21个(77.8%)血管瘤病灶表现为"填充式"强化,31个囊肿病灶无明显强化;良性肿瘤ADC10b、ADChigh、ADC3b值显著高于恶性肿瘤(P<0.05),良性肿瘤ADCperf值显著低于恶性肿瘤(P<0.05);A法、B法和C法对病灶的检出率均为100%,但诊断率存在统计学差异(P<0.05),C法(92.7%)最高,B法(83.9%)次之,A法(71.8%)最低.结论 ADC10b、ADChigh、ADC3b和ADCperf值对肝脏良恶性病变诊断优势明显,LAVA能够清楚显示肝脏病变不同时期的血供特征,DWI和LAVA技术联合应用可提高肝癌的诊断率.%Objective To explore the application of multi-b-value diffusion weighted imaging (DWI) sequence and apparent diffusion coefficient (ADC) combined with three-dimensional volumetric rapid liver multiphase dynamic enhancement technology (LAVA) in the differential diagnosis of benign and malignant liver tumors. Methods 80 patients with hepatic lesions(124 lesions) were examined by T1WI,T2WI routine scanning, and DWI (b=0,50,100,150,200,250,300,500,750 and 1000s / mm2,respectively),and we found out 124 lesions out of these patients including hepatic angeioma in 17 (27 lesions) and hepatic cyst in 23(31 lesions),as well as hepatic metastasis in 14 (23 lesions) and hepatocellular carcinoma in 26 (43 lesions). Results 31 (72.1%) lesions of hepatocellular carcinoma showed"rapid in and rapid out"enhancement,19 (82.6%) metastatic lesions showed strengthened annular edge,21 (77.8%) hemangioma showed "filling style"enhancement,31 cystic lesions were without enhancement;the ADC10b,ADChigh and ADC3b in benign lesions were significantly higher,while the ADCperf in benign lesions was significantly lower than those in malignant tumors (P<0.05);the detection of lesions by routine T1WI,T2WI and DWI scanning,or conventional T1WI,T2WI scanning and LAVA,or routine T1WI,T2WI scanning,DWI LAVA was 100%,but the accuracy was significant different (P<0.05),e.g. the highest (92.7%) by routine T1WI,T2WI scanning,DWI LAVA,in the middle (83.9%) by conventional T1WI,T2WI scanning and LAVA,and the lowest (71.8%) by routine T1WI,T2WI and DWI scanning. Conclusion The ADC10b,ADChigh,ADC3b and ADCperf can distinguish benign and malignant lesions,LAVA can clearly show the characteristics of blood supply of liver lesions at different periods,and both DWI and LAVA technology can improve the diagnosis of hepatic lesions.