水分子扩散加权成像在肝脏占位性病变鉴别诊断中的研究
摘要
【目的】探讨水分子扩散加权成像(diffusion weighted imaging，DWI)在肝脏占位性病变中的诊断、鉴别诊断价值。
【材料与方法】对7例正常志愿者，29例病人的腹部正常脏器；98例肝脏局灶性病变共172个病灶，其中肝囊肿32例57个病灶，肝血管瘤27例39个病灶，肝细胞癌24例32个病灶，转移性肿瘤15例44个病灶进行扩散加权成像，并计测表观扩散系数(apparent diffusion coefficient，ADC)。DWI序列所选用b值分别为0，50，500。同时对所有受检者行常规T_1WI、T_2WI，其中75例肝脏占位性病变行MR动态增强成像，观察病灶不同时相强化模式。
【结果】b值取(0，50)获取肝脏占位性病变的平均ADC值(除外肝囊肿)均明显大于用b值取(0，500)得到的平均ADC值(P＜0.05)。b=50s／mm~2时计测的肝囊肿、肝血管瘤、肝细胞癌、转移瘤的平均ADC值分别为：(3.71±0.30)×10~(-3)mm~2／s、(7.74±0.74)×10~(-3)mm~2／s、(5.16±0.57)×10~(-3)mm~2／s、(4.94±0.45)×10~(-3)mm~2／s。b=500s／mm~2时计测的肝囊肿、肝血管瘤、肝细胞癌、转移瘤的平均ADC值分别为：(3.35±0.31)×10~(-3)mm~2／s、(1.72±0.20)×10~(-3)mm~2／s、(1.09±0.21)×10~(-3)mm~2／s、(1.18±0.14)×10~(-3)mm~2／S。无论取低、高b值，肝囊肿、肝血管瘤与肝细胞癌及转移瘤之间平均ADC值差异显著(P＜0.001)。但肝细胞癌与转移瘤之间ADC值多有重叠，鉴别诊断有一定困难。在常规MR扫描中，肝脏占位性病变在T_1WI以低信号为主，在T_2WI大部为高或稍高信号强度。在动态增强成像中，28.1％肝细胞癌、25.6％肝血管瘤与31.8％肝转移瘤可见到门脉期及延迟期强化。
[Objective] To evaluate the value of diffusion weighted magnetic resonance imaging in diagnosis and differential diagnosis of focal liver lesions.
[Method] Diffusion weighted MR imaging and measurement of apparent diffusion coeffient (ADC value) were performed in 36 normal cases , 98 patients with172 local hepatic lesions( including hepatic cyst 57, hemangioma 39, hepatic carcinoma 32, metastasis 44) .And ADC values were calculated.. The b values were 0, 50, 500. T_1WI、 T2WI was performed in all livers. And multiphase dynamic enchancement was performed in 75 patients to observe dynamic contrast-enchanced change of the lesions.
[Result] The average ADC values of focal hepatic lesions with lower b value(0,50) were significantly higher than that with higher b value(0,500). except hepatic cyst . when b=50 s/mm~2, average ADC values of hepatic cyst、 hemangioma、 hepatic carcinoma and metastasis were (3.71±0.30)×10~(-3)mm~2/s、 (7.74±0.74) ×10~(-3)mm~2/s、 (5.16±0.57) ×10~(-3)mm~2/s、 (4.94±0.45) ×10~(-3)mm~2/s. when b=500 s/mm~2, average ADC values of hepatic cyst、 hemangioma、 hepatic carcinoma and metastasis were
(3.35±0.31) ×10~(-3)mm~2/s、 (1.72±0.20) ×10~(-3)mm~2/s、 (1.09±0.21) ×10~(-3)mm~2/s、 (1.18±0.14) ×10~(-3)mm~2/s. whether lower or higher b value, the average ADC value of malignant masses(hepatic carcinomas、 metastasis) was significantly different from that of hepatic cysts and hemangiomas(P<0.001). yet, the ADC values of metastatic tumor overlapped with those of hepatic carcinoma. In routine MRI, most of liver masses showed low signal in T_1WI and high or little high signal in T_2WI. In dynamic contrast
【材料与方法】对7例正常志愿者，29例病人的腹部正常脏器；98例肝脏局灶性病变共172个病灶，其中肝囊肿32例57个病灶，肝血管瘤27例39个病灶，肝细胞癌24例32个病灶，转移性肿瘤15例44个病灶进行扩散加权成像，并计测表观扩散系数(apparent diffusion coefficient，ADC)。DWI序列所选用b值分别为0，50，500。同时对所有受检者行常规T_1WI、T_2WI，其中75例肝脏占位性病变行MR动态增强成像，观察病灶不同时相强化模式。
【结果】b值取(0，50)获取肝脏占位性病变的平均ADC值(除外肝囊肿)均明显大于用b值取(0，500)得到的平均ADC值(P＜0.05)。b=50s／mm~2时计测的肝囊肿、肝血管瘤、肝细胞癌、转移瘤的平均ADC值分别为：(3.71±0.30)×10~(-3)mm~2／s、(7.74±0.74)×10~(-3)mm~2／s、(5.16±0.57)×10~(-3)mm~2／s、(4.94±0.45)×10~(-3)mm~2／s。b=500s／mm~2时计测的肝囊肿、肝血管瘤、肝细胞癌、转移瘤的平均ADC值分别为：(3.35±0.31)×10~(-3)mm~2／s、(1.72±0.20)×10~(-3)mm~2／s、(1.09±0.21)×10~(-3)mm~2／s、(1.18±0.14)×10~(-3)mm~2／S。无论取低、高b值，肝囊肿、肝血管瘤与肝细胞癌及转移瘤之间平均ADC值差异显著(P＜0.001)。但肝细胞癌与转移瘤之间ADC值多有重叠，鉴别诊断有一定困难。在常规MR扫描中，肝脏占位性病变在T_1WI以低信号为主，在T_2WI大部为高或稍高信号强度。在动态增强成像中，28.1％肝细胞癌、25.6％肝血管瘤与31.8％肝转移瘤可见到门脉期及延迟期强化。
[Objective] To evaluate the value of diffusion weighted magnetic resonance imaging in diagnosis and differential diagnosis of focal liver lesions.
[Method] Diffusion weighted MR imaging and measurement of apparent diffusion coeffient (ADC value) were performed in 36 normal cases , 98 patients with172 local hepatic lesions( including hepatic cyst 57, hemangioma 39, hepatic carcinoma 32, metastasis 44) .And ADC values were calculated.. The b values were 0, 50, 500. T_1WI、 T2WI was performed in all livers. And multiphase dynamic enchancement was performed in 75 patients to observe dynamic contrast-enchanced change of the lesions.
[Result] The average ADC values of focal hepatic lesions with lower b value(0,50) were significantly higher than that with higher b value(0,500). except hepatic cyst . when b=50 s/mm~2, average ADC values of hepatic cyst、 hemangioma、 hepatic carcinoma and metastasis were (3.71±0.30)×10~(-3)mm~2/s、 (7.74±0.74) ×10~(-3)mm~2/s、 (5.16±0.57) ×10~(-3)mm~2/s、 (4.94±0.45) ×10~(-3)mm~2/s. when b=500 s/mm~2, average ADC values of hepatic cyst、 hemangioma、 hepatic carcinoma and metastasis were
(3.35±0.31) ×10~(-3)mm~2/s、 (1.72±0.20) ×10~(-3)mm~2/s、 (1.09±0.21) ×10~(-3)mm~2/s、 (1.18±0.14) ×10~(-3)mm~2/s. whether lower or higher b value, the average ADC value of malignant masses(hepatic carcinomas、 metastasis) was significantly different from that of hepatic cysts and hemangiomas(P<0.001). yet, the ADC values of metastatic tumor overlapped with those of hepatic carcinoma. In routine MRI, most of liver masses showed low signal in T_1WI and high or little high signal in T_2WI. In dynamic contrast
引文
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1. Warach S, Gaa J, Siewert B et al. Acute human stroke studied by whole brain echo planar diffusion—weighted magnetic resonance imaging[J]. Ann Neurol, 1995, 37(1): 231—241.
2．杨正汉，谢敬霞。肝脏水分子扩散加权成像的初步临床应用。中华放射学杂志 1999；33：684-688．
3. Bachir T, Valerie V, Erik D et al. Evaluation of liver diffusion isotropy and characterization of focal hepatic lesion with tow single—shot echo—plan MR imaging sequences: prospective study in 66 patients[J]. Radiology, 2003, 226(1): 71-78.
4. Marks MP de CRESPIGNY a, Lentz D et al.Acute and chronic stroke: navigated spin-echo diffusion-weighted MR imaging[J] .Radiology ,1996, 1999(2) : 403-408.
5. Okada Y ,Ohtomo K , kiryu S et al . Breath-hold T2-weighted MRI of hepatic tumors: value of echo planar imaging with diffusion-sensitizing gradient[J] J Comput assist tomogr, 1998, 22 (2) :364-371.
6. Ichikawa T, Haradome H , Hachiya J et al. Diffusion-weighted MR imaging with a sigle-shot echoplanar sequences: detection and characterization of focal hepatic lesion[J]. AJR, 1998,170 (2) :397-402.
7. Muller MF, Prasad P ,Siewert B et al. Abdominal diffusion maping with use of a whole-body echo-planar system[J] .Radiology ,1994,190(2) :475-478.
8. Nolte UG , Finsterbusch J , Frahm J .Rapid isotropic diffusion maping withoutsusceptibility artifacts: whole brain studies using diffusion-weighted single-shot STEAM MR imaging[J] .Magn reson Med, 2000,44 (5): 731-736.
9. Namimoto T, Yamashita Y, Sumi S , et al. Characterization of focal liver masses with diffusion-weighted echo-planar MR imaging . Radiology 1997 ; 204: 739-744.
10. Kim T , Murakami T , Takahashi S , et al . Diffusion-weighted single-shot echoplanar MR imaging for liver disease [J]. AAJR, 1999,173 (2) :3393-398.
11. Ichikawa T , Haradome H , Hachiya J, et aal . Diffusion-weighted MR imaging with single-shot echo-planar imaging in the upper abdomen: preliminary clinical experience in 61 patients[J]. Abdom Imaging, 1999, 2224 (5): 456-461.
12. Chan JH , Tsui EY ,Luk SH ,et aal . Diffusion-weighted MR imaging of the liver: distinguishing hepatic abscess from cystic or necrotic tumor[J] . Abdom Imaging, 2001,26(2) : 161-165.
13. Moteki T , Horikoshi H, Oya N, et al. Evaluation of hepatic parenchy ma using Diffusion-weighted reordered turbo FLASH magnetic resonance images[J] J Magn Reson Imaging, 2002,15 (5): 564-572.
14. Le Bihan D ,Breton E ,Lalle mand et al. Separation of diffusion and perfusion in intravvoxel incoherrrent motion MR imaging[J]. Radiology, 1998, 168(2): 497-505.
15. Le Bihan D, Breton E, Lalle mand et al. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neeeurologic disorders[J]. Radiology, 1986, 1161(2): 401-407.
16．陈再智，杨正汉，吴玉林 等。肝脏局灶病变血供对表观扩散系数的影响[J]。中华放射学杂志，2002，36(10)：892-895．
17. Patel MR, Sieweert B, Warach S, et al. diffusion and perfusion imaging techniques MRI clin North Am, 1995 3: 425.
18. Yamadaa I, Aung W, Himeno Y, et aal. diffusion coefficients in abdominal organs hepatic lesion: evaluation with intravoxel incoherent motion echo-planar MR imaging[J]. Raadiology, 1999, 210(3): 6117-623.
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2. Ichiro Y, Winn A, Yoshiro H, et al. Diffusion coefficients in Abdominal Organs and Hepatic Lesions: Evaluation with Intravoxel Incoherent Motion Echo-planar MR Imaging. Radiology, 1999, 210: 617-623.
3. Yamada I, Yoshiro H, Tsukasa N, et al. Moyamoya Disease: Evaluation with Diffusion-weighted and perfusion Echo-planar MR Imaging. Radiology, 1999, 212: 340-347.
4. Warach S, Gaa J, Siewert B, et al. Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol, 1995, 37: 231-241.
5. Marks MP, De Crespigny A, Lentz D, et al. Acute and chronic st-roke: navigated spin-echo diffusion-weighted MR imaging. Radiology, 1996, 199: 403-408.
6. Kodoya M, Matsui O, Takashima T, et al. Hepatocellular carcinoma: correlation of MR imaging and histopathologic findings[J]. Raiology, 1993; 183.
7. Giuseppe B, Michaede A, et al. Hemangioma in the Cirrhotic Liver: Diagnosis and Natural History. Radiology 2001 219: 69-75.
8. Krinsky GA, Lee VS, Theise ND. Focal lesion in the cirrhotic liver: high resolution MRI with pathologic correlation. Comput Assist Tomogr, 2000, 24: 189-195.
9. Mitchell DG, Palazzo J, Hann HW, et al. Hepatocellular tumors with high signal on T1-weighted MR images: chemical shift MR imaging and histologic-correlation. Comput Assisst Tomogr, 1991, 15: 762-769.
10. Kadoya M, Matsui O, Takashima T, et al. Hepatocellular carcinoma: Correlation of Mrimaging and histopathologic findings. Radiology, 1992, 183: 819-825.
11．杨正汉，谢敬霞，等．水分子扩散加权磁共振成像在肝脏临床应用[J]．中华放射学杂志，1999，33(10)：684-688．
12．陆建平，王莉．动态增强磁共振成像诊断肝占位的价值[J]．第二军医大学学报，2000，21(6)：575-578
13. Ohtomo K, Itai Y, Yoshikawa K, et al. Hepatocellular carcinoma and cavern-ous hemangioma: differentiation with MR imaging. Radiology, 1988, 168: 621～623.
14. Goldberg MA, Hahn PF, Saini S, et al. Value of T1 and T2 relaxation times from echo-planar MR imaging in the characterization of focal hepatic lesions. AJR, 1993, 160: 1011～1017.
15．韩鸿宾．临床磁共振成像序列设计与应用[M]，北京，北京大学医学出版社，2003，101-103．
16. Yamada I. Aung W, Himeno Y, ET AL. Diffision coefficients in abdominai organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology, 1999, 210(3): 617-623.
17. Moteki T, Horikoshi H, Oya N, et al. Evaluation of hepatic lesions and hepatic parenchyma using diffusion-weighted reordered turbo FLASH magnetic resonance images, Magn Reson Imaging, 2002, 15(5): 564-572.
18. Taouli B, Vilgrain V. Dumont E, et al. Evaluation of liver diffusion isotropy and chcharacterization of heptic lesion with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology, 2003, 226: 71-78.
19. Murtz P, Flacke S, Traber F, et al. Abodomen: diffusion-weighted MR imaging with pulse-triggered single-shot sequences. Radiology, 2002, 224(1): 258-264.
20. Chenevert TL, Brunberg JA, Pipe JC. Anisotropic diffusion in human white matter: Demonstration with MR teclmiqus in vivo. Radiology, 1990, 177: 401-405.
21. Le Bihan D, Turner R, Moonen CT, et al. Imaging of diffusion and microcirculation with gradient sensitization: design, strategy, and significance. Magn Rason Imaging, 1991, 1: 7-28.
22. Herneth AM, Guccione S, Bednarski M. Apparent diffusion coefficient: a quantitative parameter for in vivo tumor characterization. Euro Radiology, 2003, 45: 208-213.
23. Eis M, Els T, Hoehn-Berlage M. High resolution quantitative relaxation and diffusion MRI of three experimental brain tumors in rats. Magn Reson Med, 1995, 34: 835-844
24. Le bihan D, Breton E, Lallemand D, et al. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology, 1988, 168: 497-505
25．汤光宇，姚冀平，徐U，等．鉴别良、恶性椎体骨折的最佳扩散敏感系数值的探讨[J]．中华放射学杂志，2004，38：615-619．
26. Markkus f, Pottumarthi P, Bettina S, et al. Abodominal diffusion mapping with use of a whole-body echo-planar system. Radiology, 1994, 190: 475-478.
27. Okada Y, Ohtomo K, kiryu S et al. Breath-hold T2-weighted MRI of hepatic tumors: value of echo planar imaging with diffusion-sensitizing gradient. J Comput assist tomogr, 1998, 22(2): 364-371.
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