磁共振扩散张量成像在肝癌及肝转移瘤中诊断价值
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摘要
目的探讨磁共振扩散张量成像(DTI)对原发性肝癌及肝转移瘤的诊断价值。方法回顾性分析郑州大学附属肿瘤医院2016年1—12月收治、经病理学诊断证实为原发性肝癌或肝转移瘤的42例病人的磁共振成像(MRI)与DTI资料,统计其各向异性分数(FA)值及平均扩散系数(ADC)值,分析两者在不同类型疾病中的差异性。结果不同疾病类型的FA值和ADC值有所不同,其中FA值自高而低分别为食管癌肝转移瘤(0. 641±0. 054)、胰腺癌肝转移瘤(0. 602±0. 064)、肺癌肝转移瘤(0. 525±0. 103)、肝癌(0. 488±0. 041)、直肠癌肝转移瘤(0. 301±0. 077)和胆囊癌肝转移瘤(0. 284±0. 059),各个类型之间的差异均有统计学意义(P <0. 05); ADC值自高而低分别为胰腺癌肝转移瘤(1. 95±0. 21)×10~(-3)mm~2/s、结直肠癌肝转移瘤(1. 81±0. 17)×10~(-3)mm~2/s、肝癌(1. 68±0. 17)×10~(-3)mm~2/s、食管癌肝转移瘤(1. 52±0. 21)×10~(-3)mm~2/s、肺癌肝转移瘤(1. 44±0. 14)×10~(-3)mm~2/s、胆囊癌肝转移瘤(1. 22±0. 09)×10~(-3)mm~2/s,各个类型之间的差异均有统计学意义(P <0. 05)。结论肝脏MRI与DTI序列联合检测可获得较全面的信息,有助于肝癌及肝转移瘤的诊断和鉴别诊断。
Objective To investigate the diagnosis value of magnetic resonance diffusion tensor imaging( DTI) for primary liver cancer and liver metastases. Methods The MRI and DTI data of 42 patients with HCC or liver metastases confirmed by pathology were analyzed. The value of anisotropy fraction( FA) and mean diffusion coefficient( ADC) of subjects were compared between different kinds of disease. Results: There was significant difference between different kinds of disease in both FA and ADC value. The FA values from high to low were respectively esophageal cancer liver metastasis( 0. 641 ± 0. 054),pancreatic cancer liver metastasis( 0. 602 ±0. 064),lung cancer liver metastasis( 0. 525 ± 0. 103),liver cancer( 0. 488 ± 0. 041),colorectal cancer liver metastasis( 0. 301 ±0. 077) and gallbladder cancer liver metastasis( 0. 284 ± 0. 059),and the differences between each type were statistically significant( P < 0. 05). The ADC values from high to low were respectively pancreatic cancer liver metastasis [( 1. 95 ± 0. 21) × 10~(-3) mm~2/s],colorectal cancer liver metastasis [( 1. 81 ± 0. 17) × 10~(-3) mm~2/s],liver cancer [( 1. 68 ± 0. 17) × 10~(-3) mm~2/s],esophageal cancer liver metastasis [( 1. 52 ± 0. 21) × 10~(-3) mm~2/s],lung cancer liver metastasis [( 1. 44 ± 0. 14) × 10~(-3) mm~2/s],gallbladder cancer liver metastasis [( 1. 22 ± 0. 09) × 10~(-3) mm~2/s]he differences among all types were statistically significant( P < 0. 05). Conclusion Liver MRI and DTI detect could obtain a comprehensive information,contributing to the diagnosis and differential diagnosis of liver cancer and liver metastases.
Objective To investigate the diagnosis value of magnetic resonance diffusion tensor imaging( DTI) for primary liver cancer and liver metastases. Methods The MRI and DTI data of 42 patients with HCC or liver metastases confirmed by pathology were analyzed. The value of anisotropy fraction( FA) and mean diffusion coefficient( ADC) of subjects were compared between different kinds of disease. Results: There was significant difference between different kinds of disease in both FA and ADC value. The FA values from high to low were respectively esophageal cancer liver metastasis( 0. 641 ± 0. 054),pancreatic cancer liver metastasis( 0. 602 ±0. 064),lung cancer liver metastasis( 0. 525 ± 0. 103),liver cancer( 0. 488 ± 0. 041),colorectal cancer liver metastasis( 0. 301 ±0. 077) and gallbladder cancer liver metastasis( 0. 284 ± 0. 059),and the differences between each type were statistically significant( P < 0. 05). The ADC values from high to low were respectively pancreatic cancer liver metastasis [( 1. 95 ± 0. 21) × 10~(-3) mm~2/s],colorectal cancer liver metastasis [( 1. 81 ± 0. 17) × 10~(-3) mm~2/s],liver cancer [( 1. 68 ± 0. 17) × 10~(-3) mm~2/s],esophageal cancer liver metastasis [( 1. 52 ± 0. 21) × 10~(-3) mm~2/s],lung cancer liver metastasis [( 1. 44 ± 0. 14) × 10~(-3) mm~2/s],gallbladder cancer liver metastasis [( 1. 22 ± 0. 09) × 10~(-3) mm~2/s]he differences among all types were statistically significant( P < 0. 05). Conclusion Liver MRI and DTI detect could obtain a comprehensive information,contributing to the diagnosis and differential diagnosis of liver cancer and liver metastases.
引文
[1]李丹燕,何健,朱斌,等.肝脏原发及转移性恶性肿瘤不同b值DWI的ADC值特点及变化趋势[J].实用放射学杂志,2013,29(12):1948-1952,1962.
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[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(6):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. Assessment of diffusion tensor MR imaging(DTI)in liver fibrosis with minimal confounding effect of hepatic steatosis[J].Magn Reson Med,2015,73:1602-1608.
[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(7):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]李丹燕,何健,朱斌,等.肝脏原发及转移性恶性肿瘤不同b值DWI的ADC值特点及变化趋势[J].实用放射学杂志,2013,29(12):1948-1952.
[14]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.
[15] 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,2013,82:203-207.
[16]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.
[17] 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,2016,16:227-233.
[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 Ther,2016,9:4089-4098.
[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. DOI:10.1371/journal. pone. 0135568.
[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. DOI:10. 1371/journal. pone. 0101944.
[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(6):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. Assessment of diffusion tensor MR imaging(DTI)in liver fibrosis with minimal confounding effect of hepatic steatosis[J].Magn Reson Med,2015,73:1602-1608.
[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(7):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]李丹燕,何健,朱斌,等.肝脏原发及转移性恶性肿瘤不同b值DWI的ADC值特点及变化趋势[J].实用放射学杂志,2013,29(12):1948-1952.
[14]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.
[15] 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,2013,82:203-207.
[16]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.
[17] 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.