磁共振扩散张量成像在肝细胞癌及肝转移瘤鉴别诊断价值研究
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摘要
目的探讨磁共振扩散张量成像(DTI)在原发性肝细胞癌(HCC)及肝转移瘤的诊断价值。方法选取经病理或临床所证实的HCC及肝转移瘤的患者为研究对象,其中HCC 15例,肝转移瘤27例(胰腺癌肝转移瘤8例,结肠癌肝转移瘤7例,胆囊癌肝转移瘤5例,肺癌肝转移瘤3例,食管癌肝转移瘤4例),所有受试者均行肝脏常规MRI及DTI检查,并进行图像后处理技术,测量各向异性分数(FA)值及平均扩散系数(ADC)值,FA和ADC值均值比较采用多组样本方差分析检验,P<0.05为差异具有统计学意义。结果肝癌组、胰腺癌肝转移瘤、结直肠癌肝转移瘤、肺癌肝转移瘤、胆囊癌肝转移瘤及食管癌肝转移瘤FA值分别为(0.486±0.0397)、(0.589±0.0461)、(0.292±0.0742)、(0.513±0.1141)、(0.264±0.0529)和(0.625±0.0262)。上述各组的ADC值分别为(1.71±0.1694)×10~(-3)、(2.02±0.1760)×10~(-3)、(1.85±0.7322)×10~(-3)、(1.51±0.1392)×10~(-3)、(1.19±0.0713)×10~(-3)、(1.66±0.2450)×10~(-3)mm~2/s。肝癌与部分组肝转移瘤FA值及ADC值比较,差异具有统计学意义(P<0.05),且部分组肝转移瘤之间FA值及ADC值比较差异具有统计学意义(P<0.05),将部分与肝癌组FA值及ADC值存在差异的肝转移瘤组比较得出的ROC曲线、特异度及灵敏度均有统计学价值。结论肝脏DTI序列联合常规磁共振成像序列结合可获得更为全面的信息,有助于肝细胞癌及部分肝转移瘤的鉴别诊断。
Objective To investigate the diagnostic value of magnetic resonance diffusion tensor imaging(DTI)in primary hepatocellular carcinoma(HCC)and hepatic metastases.Methods Patients with HCC and liver metastases confirmed by pathology or clinic were selected as subjects.There were 15 cases of HCC and 27 cases of hepatic metastases(8 cases of pancreatic liver metastases,7 cases of colon metastases,5 cases of gallbladder liver metastases,3 cases of lung metastases,4 cases of esophageal liver metastases).All subjects underwent conventional liver MRI and DTI examinations,and performed image post-processing techniques to measure anisotropic fraction(FA)values and mean diffusion coefficient(ADC)values.FA and ADC mean values were compared using multi-sample analysis of variance analysis,P<0.05 was considered statistically significant.Results The FA values of liver cancer group,pancreatic cancer liver metastases,colorectal cancer liver metastases,lung cancer liver metastases,gallbladder cancer liver metastases,and esophageal cancer liver metastases were(0.486±0.0397),(0.589±0.0461),(0.292±0.0742),(0.513±0.1141),(0.264±0.0529),and(0.625±0.0262).The ADC values of the above groups were(1.71±0.1694)×10~(-3),(2.02±0.1760)×10~(-3),(1.85±0.7322)×10~(-3),(1.51±0.1392)×10~(-3),(1.19±0.0713)×10~(-3),(1.66±0.2450)×10~(-3)mm~2/s.The difference in FA and ADC values between hepatocellular carcinoma and hepatic metastases in some groups was statistically significant(P<0.05),and the FA value and ADC value between hepatic metastases in some groups were statistically significant(P<0.05).The ROC curve,specificity and sensitivity of the hepatic metastases group with differences in FA values and ADC values in some liver cancer groups were statistically significant.Conclusion The combination of liver DTI sequence and conventional magnetic resonance imaging sequence can obtain more comprehensive information,which is helpful for the differential diagnosis of hepatocellular carcinoma and some hepatic metastases.
Objective To investigate the diagnostic value of magnetic resonance diffusion tensor imaging(DTI)in primary hepatocellular carcinoma(HCC)and hepatic metastases.Methods Patients with HCC and liver metastases confirmed by pathology or clinic were selected as subjects.There were 15 cases of HCC and 27 cases of hepatic metastases(8 cases of pancreatic liver metastases,7 cases of colon metastases,5 cases of gallbladder liver metastases,3 cases of lung metastases,4 cases of esophageal liver metastases).All subjects underwent conventional liver MRI and DTI examinations,and performed image post-processing techniques to measure anisotropic fraction(FA)values and mean diffusion coefficient(ADC)values.FA and ADC mean values were compared using multi-sample analysis of variance analysis,P<0.05 was considered statistically significant.Results The FA values of liver cancer group,pancreatic cancer liver metastases,colorectal cancer liver metastases,lung cancer liver metastases,gallbladder cancer liver metastases,and esophageal cancer liver metastases were(0.486±0.0397),(0.589±0.0461),(0.292±0.0742),(0.513±0.1141),(0.264±0.0529),and(0.625±0.0262).The ADC values of the above groups were(1.71±0.1694)×10~(-3),(2.02±0.1760)×10~(-3),(1.85±0.7322)×10~(-3),(1.51±0.1392)×10~(-3),(1.19±0.0713)×10~(-3),(1.66±0.2450)×10~(-3)mm~2/s.The difference in FA and ADC values between hepatocellular carcinoma and hepatic metastases in some groups was statistically significant(P<0.05),and the FA value and ADC value between hepatic metastases in some groups were statistically significant(P<0.05).The ROC curve,specificity and sensitivity of the hepatic metastases group with differences in FA values and ADC values in some liver cancer groups were statistically significant.Conclusion The combination of liver DTI sequence and conventional magnetic resonance imaging sequence can obtain more comprehensive information,which is helpful for the differential diagnosis of hepatocellular carcinoma and some hepatic metastases.
引文
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[11]陈丽华,刘爱连,宋清伟,等.磁共振扩散张量成像鉴别诊断肝内胆管细胞癌与肝细胞癌[J].中国医学影像技术,2017,33(07):993-997.
[12]刘奇志,谢晓奕,吴卫华,等.肺癌肝转移瘤二维超声表现与组织病理类型的相关研究[J].中国临床医学,2012,19(3):298-299.
[13]沈亚琪,胡道予,李建军等.DTI对两种肝纤维化动物模型的定量研究[J].放射学实践,2012,27(2):145-150.
[14]Tosun M,Inan N,Sarisoy HT,et al.Diagnostic performance of conventional diffusion weighted imaging and diffusion tensor imaging for the liver fibrosis and inflammation[J].Eur J Radiol,2013,82(2):203-207.
[15]张丽,胡道予,夏黎明,等.MR-DTI在肝硬化早期诊断中的应用价值[J].实用放射学杂志,2009,25(12):1748-1752.
[16]Wong OL,Gloh Lo G,Lee R,et al.The effect of respiratory and cardiac motion in liver diffusion tensor imaging(DTI)[J].J Comput Assist Tomogr,2014,38(3):352-359.
[2]Tokgoz O,Unlu E,Unal I,et al.Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver[J].Afr Health Sci,2016,16(1):227-233.
[3]Pieper CC,Meyer C,Sprinkart AM,et al.The value of intravoxel incoherent motion model-based diffusion-weighted imaging for outcome prediction in resin-based radioembolization of breast cancer liver metastases[J].Onco Targets Ther2016,9(Issue 1):4089-4098.
[4]Li X,Liang Q,Zhuang L,et al.Preliminary study of MR diffusion tensor imaging of the liver for the diagnosis of hepatocellular carcinoma[J].PLo S One,2015,10(8):e0135568.
[5]Testa ML,Chojniak R,Sene LS,et al.Is DWI ADC a useful tool in the characterization of focal hepatic lesions suspected of malignancy[J].PLo S One,2014,9(7):e101944.
[6]陶乙宣,范国光.磁共振扩散张量成像技术在脑肿瘤手术前后的临床应用价值[J].临床放射学杂志,2017,36(06):775-778.
[7]Erturk SM,Ichikawa T,Kaya E,et al.Diffusion tensor imaging of cysts,hemangimas,and metastases of the liver[J].Magn Reson Med,2015,73(4):1602-1608.
[8]赵广强,翁苓苓,陈义磊,等.弥散加权成像与弥散张量成像评价肝纤维化的实验研究[J].医学影像学杂志,2016,26(1):99-103.
[9]Lee Y,Kim H.Assessment of diffusion tensor MR imaging(DTI)in liver fibrosis with minimal confounding effect of hepatic steatosis[J].Magn Reson Med,2015,73(4):1602-1608.
[10]周卫兵,龚良庚,任海波,等.磁共振扩散张量成像在肝脏局灶性病变诊断中的应用[J].南昌大学学报(医学版),2014,54(3):18-21.
[11]陈丽华,刘爱连,宋清伟,等.磁共振扩散张量成像鉴别诊断肝内胆管细胞癌与肝细胞癌[J].中国医学影像技术,2017,33(07):993-997.
[12]刘奇志,谢晓奕,吴卫华,等.肺癌肝转移瘤二维超声表现与组织病理类型的相关研究[J].中国临床医学,2012,19(3):298-299.
[13]沈亚琪,胡道予,李建军等.DTI对两种肝纤维化动物模型的定量研究[J].放射学实践,2012,27(2):145-150.
[14]Tosun M,Inan N,Sarisoy HT,et al.Diagnostic performance of conventional diffusion weighted imaging and diffusion tensor imaging for the liver fibrosis and inflammation[J].Eur J Radiol,2013,82(2):203-207.
[15]张丽,胡道予,夏黎明,等.MR-DTI在肝硬化早期诊断中的应用价值[J].实用放射学杂志,2009,25(12):1748-1752.
[16]Wong OL,Gloh Lo G,Lee R,et al.The effect of respiratory and cardiac motion in liver diffusion tensor imaging(DTI)[J].J Comput Assist Tomogr,2014,38(3):352-359.