基于LI-RADS多参数MRI诊断肝细胞癌的研究进展
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摘要
肝细胞癌是常见的恶性肿瘤,早期与准确地诊断对于临床治疗与患者预后至关重要。MRI在软组织病变的显示方面有着巨大优势,随着近年来MRI功能成像技术的不断发展,诸如扩散加权成像、磁共振动态增强成像等在内的多种新技术能够无创地从细胞甚至分子层面了解肝脏的能量代谢、血流等方面的变化,结合传统的T1、T2加权成像及脂肪抑制技术使得肝癌的检出率、准确率大大提高。肝脏影像报告和数据管理系统旨在规范病变的影像描述,标准化影像诊断术语。本文就基于LI-RADS的多参数MRI诊断肝细胞癌的研究进展进行综述。
Hepatocellular carcinoma is a common malignant tumor. Early and exact diagnosis of the disease is crucial for clinical treatment and patients' prognosis. MRI has enormous advantage in the detection of soft tissue lesions. With the continuous development of MRI functional imaging technique in recent years,multiple kinds of new techniques such as diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging can non-invasively learn the changes in energy metabolism and blood flow of the liver from cellular level and even molecular level,and the detectable rate of hepatocellular carcinoma and the accuracy rate have been greatly enhanced when traditional T1 and T2-weighted imaging and fat suppression technique are combined. The liver imaging reports and the data management system are aimed at normalizing the image description of lesions and standardizing the terms of imaging diagnosis. This paper is a review of the research progress of the diagnosis of hepatocellular carcinoma by LI-RADS based multi-parameter MRI.
Hepatocellular carcinoma is a common malignant tumor. Early and exact diagnosis of the disease is crucial for clinical treatment and patients' prognosis. MRI has enormous advantage in the detection of soft tissue lesions. With the continuous development of MRI functional imaging technique in recent years,multiple kinds of new techniques such as diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging can non-invasively learn the changes in energy metabolism and blood flow of the liver from cellular level and even molecular level,and the detectable rate of hepatocellular carcinoma and the accuracy rate have been greatly enhanced when traditional T1 and T2-weighted imaging and fat suppression technique are combined. The liver imaging reports and the data management system are aimed at normalizing the image description of lesions and standardizing the terms of imaging diagnosis. This paper is a review of the research progress of the diagnosis of hepatocellular carcinoma by LI-RADS based multi-parameter MRI.
引文
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[2]Wang H,He L,Dong JH. Risk factors affecting the prognosis of primary liver cancer after surgical treatment[J]. Journal of Navy Medicine,2017,38(1):43-45.[王鹤,何蕾,董家鸿.原发性肝癌手术治疗的预后因素分析[J].海军医学杂志,2017,38(1):43-45.]
[3]Zhang JH,Ma YM,Yan B. Analysis of combined detection of three indexes in diagnosis of primary liver cancer[J]. International Journal of Laboratory Medicine,2017,38(1):92-93.[张建华,马玉梅,闫波. 3种指标联合检测诊断原发性肝癌的分析[J].国际检验医学杂志,2017,38(1):92-93.]
[4]Zhao W,Li WZ,Yi XP,et al. Diagnostic value of liver imaging reporting and data system MRI on primary hepatocellular carcinoma[J]. Journal of Central South University(Medical Sciences),2016,41(4):380-387.[赵伟,李文政,易小平,等.应用肝影像报告和数据系统MRI分级标准诊断原发性肝癌的诊断效能评价[J].中南大学学报(医学版),2016,41(4):380-387.]
[5]Zhang DF,Li ZH,Duan XK,et al. Diagnositic efficacy of the MRI LI-RADS classififation for hepatocellular carcinoma[J]. Radiologic Practice,2016,31(4):303-306.[张大福,李振辉,段学昆,等. LI-RADS MRI分类标准对肝细胞癌的诊断效能[J].放射学实践,2016,31(4):303-306.]
[6]Joo I,Lee JM,Lee SM,et al. Diagnostic accuracy of liver imaging reporting and data system(LI-RADS)v2014 for intrahepatic mass-forming cholangiocarcinomas in patients with chronic liver disease on gadoxetic acid-enhanced MRI[J]. Journal of Magnetic Resonance Imaging,2016,44(5):1330-1338.
[7]Wang H,Guo XC,Wang K,et al. Recognition of the MR imaging features of HCC foci in cirrhotic liver:Based on LI-RADS(2014)definition[J]. Radiologic Practice,2016,31(4):296-299.[王鹤,郭小超,王可,等.乙肝肝硬化背景下肝细胞肝癌的MRI表现:LI-RADS(2014版)定义征象的识别率分析[J].放射学实践,2016,31(4):296-299.]
[8]Li S,Wang K. To investigate the liver dysplastic nodules and early diagnosis of small hepatocellular carcinoma MRI[J]. Modern Medical Imagelogy,2015,24(6):887-891.[李松,王琨.肝脏退变结节与早期小肝癌MRI诊断的探讨[J].现代医用影像学,2015,24(6):887-891.]
[9]Yuan JS,Zhao ZW,Sheng L. Explore the application value of high field MRI in the differential diagnosis of DN and SHCC[J]. Chinese Journal of CT and MRI,2017,15(4):90-92.[袁劲松,赵志伟,盛练.高场强MRI对肝硬化退变结节和小肝癌诊断与鉴别诊断价值研究[J].中国CT和MRI杂志,2017,15(4):90-92.]
[10]Kong Y,Li WM. The application of dynamic contrast enhanced MRI in the diagnosis of primary hepatocellular carcinoma[J].Chinese Journal of New Clinical Medicine,2016,9(5):387-390.[孔源,李文美.磁共振动态增强成像在原发性肝癌诊断中的应用研究[J].中国临床新医学,2016,9(5):387-390.]
[11]Xu YJ,Chen HM,Zhai YJ,et al. The application of the quantitative analysis of three-dimensional whole-liver DCE-MRI in the diagnosis of hepatic tumors[J]. Journal of Bengbu Medical College,2016,41(9):1230-1234.[徐运军,程慧敏,翟羽佳,等.三维全肝MRI动态增强扫描定量分析在肝脏肿瘤诊断中的应用[J].蚌埠医学院学报,2016,41(9):1230-1234.]
[12]Yu Sufu·Rouzi,Wang Yunling,Wang Hong,et al. DCE-MRI in differential diagnosis of liver lesions[J]. Journal of China Clinic Medical Imaging,2015,26(4):260-263.[玉苏甫·肉孜,王云玲,王红,等. DCE-MRI鉴别肝脏占位性病变的研究[J].中国临床医学影像杂志,2015,26(4):260-263.]
[13]Guo TC,Wu CY,Wen YX,et al. Sesonance enhanced imaging in differentiating liver cirrhosis nodules and the clinical application of small liver cancer research[J]. Chinese Journal of CT and MRI,2015,13(10):63-65.[郭天畅,伍彩云,温运雄,等.普美显磁共振增强成像在鉴别肝硬化结节与小肝癌的临床应用研究[J].中国CT和MRI杂志,2015,13(10):63-65.]
[14]Fang WL,Yang QY,Zhai JC,et al. Application of Gd-EOBDTPA enhanced MRI in the early imaging diagnosis of hepatocellular carcinoma[J]. Hainan Medical Journal,2017,28(3):432-434.[方文亮,杨秋云,翟建春,等.普美显MRI在肝癌早期影像诊断中的应用[J].海南医学,2017,28(3):432-434.]
[15]Joo I,Lee JM,Lee DH,et al. Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI:Can hypointensity on the hepatobiliary phase be used as an alternative to washout[J]? European Radiology,2015,25(10):2859-2868.
[16]Guo XC,Wang H,Wang K,et al. Recognition rate of the MDCT imaging features of hepatocellular carcinoma in cirrhotic liver:Based on LI-RADS(v2014)definition[J]. Radiologic Practice,2016,31(4):300-302.[郭小超,王鹤,王可,等.肝硬化背景下肝细胞癌的CT动态增强表现:LI-RADS(2014版)定义征象的出现率[J].放射学实践,2016,31(4):300-302.]
[17]Xie YH,Yu YQ,Qian YF,et al. The value of DWI in differentiating hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Journal of Clinical Radiology,2016,35(6):887-890.[谢玉海,余永强,钱银锋,等.扩散加权成像在鉴别肝细胞肝癌和周围型胆管细胞癌中的价值[J].临床放射学杂志,2016,35(6):887-890.]
[18]Chen YH,Lu J,Miu XF,et al. The value of DWI and ADC in the diagnosis of small liver cancer[J]. Jiangsu Medical Journal,2016,42(1):94-96.[陈月华,陆健,缪小芬,等.弥散加权成像及其表观弥散系数诊断小肝癌的价值[J].江苏医药,2016,42(1):94-96.]
[19]Yan YW,Rao SX,Yu MY. Value of ADC value for prediction of microvascular invasion of hepatocellular carcinoma[J]. Journal of Clinical Radiology,2016,35(1):93-95.[晏耀文,饶圣祥,俞梦勇.扩散加权成像在预测肝细胞肝癌微血管浸润的价值[J].临床放射学杂志,2016,35(1):93-95.]
[20]Zhang K,Li XB,Ma JX,et al. The correlation between the minimum and average ADC values of hepatocellular carcinoma and pathological grade[J]. Journal of Clinical Radiology,2016,35(5):728-731.[张坤,李绪斌,马菊香,等.肝细胞肝癌肿瘤ADC值与病理分级的相关性研究[J].临床放射学杂志,2016,35(5):728-731.]
[21]Ma XH,Wang S,Zhao XM,et al. The predictive value of IVIMDWI on short-term therapeutic effect and prognosis of TACE on hepatocellular carcinoma[J]. Chinese Journal of Magnetic Resonance Imaging,2017,8(04):248-253.[马霄虹,王爽,赵心明,等.体素内不相干运动扩散加权成像对肝癌经导管肝动脉化疗栓塞治疗短期疗效预测及评估的价值[J].磁共振成像,2017,8(04):248-253.]
[22]Hicks RM,Yee J,Ohliger MA,et al. Comparison of diffusionweighted imaging and T2-weighted single shot fast spin-echo:Implications for LI-RADS characterization of hepatocellular carcinoma[J]. Magnetic Resonance Imaging,2016,34(7):915-921.
[23]Li XJ,Meng XY,Chen X,et al. The diagnostic value of intravoxel incoherent motion diffusion-weighted imaging in evaluating hepatic lesions[J]. Radiologic Practice,2016,31(6):526-530.[李晓娟,孟晓岩,陈晓,等.体素内不相干运动磁共振扩散加权成像诊断肝脏占位性病变[J].放射学实践,2016,31(6):526-530.]
[24]Granata V,Fusco R,Catalano O,et al. Intravoxel incoherent motion(IVIM)in diffusion-weighted imaging(DWI)for hepatocellular carcinoma:Correlation with histologic grade[J]. Oncotarget,2016,7(48):79357-79364.
[25]Yang FH,Pu FS,Luo JB,et al. The application value of magnetic resonance enhancement combined with DWI in the diagnosis of liver tumor[J]. Modern Medical Imageology,2015,24(3):470-471.[杨富辉,普福顺,罗家滨,等.磁共振增强联合DWI技术在肝脏肿瘤诊断中的应用价值[J].现代医用影像学,2015,24(3):470-471.]
[26]Miao H,Zhao R,Ma X,et al. The diagnostic value of DWI combined dynamic contrast enhanced MRI in focal hepatic lesions[J]. China Practical Medicine,2017,12(8):98-99.[苗红,赵蕊,马茜,等. DWI联合磁共振动态增强扫描在肝脏局灶性占位病变的诊断价值[J].中国实用医药,2017,12(8):98-99.]
[27]Yuan WJ,Liu YT,Luo SB,et al. The clinical application value of DWI combined with GRE/T2W*multi-echo magnetic resonance imaging and serum AFP as well as carcinoembryonic antigen in evaluation of benign and malignant occupying lesions of liver[J].Journal of Medical Imaging,2015,25(10):1831-1835.[袁维军,刘永泰,骆世兵,等.磁共振DWI联合GRE/T2W*多回波技术与血清AFP联合癌胚抗原评估肝脏良恶占位性病变临床应用价值[J].医学影像学杂志,2015,25(10):1831-1835.]
[2]Wang H,He L,Dong JH. Risk factors affecting the prognosis of primary liver cancer after surgical treatment[J]. Journal of Navy Medicine,2017,38(1):43-45.[王鹤,何蕾,董家鸿.原发性肝癌手术治疗的预后因素分析[J].海军医学杂志,2017,38(1):43-45.]
[3]Zhang JH,Ma YM,Yan B. Analysis of combined detection of three indexes in diagnosis of primary liver cancer[J]. International Journal of Laboratory Medicine,2017,38(1):92-93.[张建华,马玉梅,闫波. 3种指标联合检测诊断原发性肝癌的分析[J].国际检验医学杂志,2017,38(1):92-93.]
[4]Zhao W,Li WZ,Yi XP,et al. Diagnostic value of liver imaging reporting and data system MRI on primary hepatocellular carcinoma[J]. Journal of Central South University(Medical Sciences),2016,41(4):380-387.[赵伟,李文政,易小平,等.应用肝影像报告和数据系统MRI分级标准诊断原发性肝癌的诊断效能评价[J].中南大学学报(医学版),2016,41(4):380-387.]
[5]Zhang DF,Li ZH,Duan XK,et al. Diagnositic efficacy of the MRI LI-RADS classififation for hepatocellular carcinoma[J]. Radiologic Practice,2016,31(4):303-306.[张大福,李振辉,段学昆,等. LI-RADS MRI分类标准对肝细胞癌的诊断效能[J].放射学实践,2016,31(4):303-306.]
[6]Joo I,Lee JM,Lee SM,et al. Diagnostic accuracy of liver imaging reporting and data system(LI-RADS)v2014 for intrahepatic mass-forming cholangiocarcinomas in patients with chronic liver disease on gadoxetic acid-enhanced MRI[J]. Journal of Magnetic Resonance Imaging,2016,44(5):1330-1338.
[7]Wang H,Guo XC,Wang K,et al. Recognition of the MR imaging features of HCC foci in cirrhotic liver:Based on LI-RADS(2014)definition[J]. Radiologic Practice,2016,31(4):296-299.[王鹤,郭小超,王可,等.乙肝肝硬化背景下肝细胞肝癌的MRI表现:LI-RADS(2014版)定义征象的识别率分析[J].放射学实践,2016,31(4):296-299.]
[8]Li S,Wang K. To investigate the liver dysplastic nodules and early diagnosis of small hepatocellular carcinoma MRI[J]. Modern Medical Imagelogy,2015,24(6):887-891.[李松,王琨.肝脏退变结节与早期小肝癌MRI诊断的探讨[J].现代医用影像学,2015,24(6):887-891.]
[9]Yuan JS,Zhao ZW,Sheng L. Explore the application value of high field MRI in the differential diagnosis of DN and SHCC[J]. Chinese Journal of CT and MRI,2017,15(4):90-92.[袁劲松,赵志伟,盛练.高场强MRI对肝硬化退变结节和小肝癌诊断与鉴别诊断价值研究[J].中国CT和MRI杂志,2017,15(4):90-92.]
[10]Kong Y,Li WM. The application of dynamic contrast enhanced MRI in the diagnosis of primary hepatocellular carcinoma[J].Chinese Journal of New Clinical Medicine,2016,9(5):387-390.[孔源,李文美.磁共振动态增强成像在原发性肝癌诊断中的应用研究[J].中国临床新医学,2016,9(5):387-390.]
[11]Xu YJ,Chen HM,Zhai YJ,et al. The application of the quantitative analysis of three-dimensional whole-liver DCE-MRI in the diagnosis of hepatic tumors[J]. Journal of Bengbu Medical College,2016,41(9):1230-1234.[徐运军,程慧敏,翟羽佳,等.三维全肝MRI动态增强扫描定量分析在肝脏肿瘤诊断中的应用[J].蚌埠医学院学报,2016,41(9):1230-1234.]
[12]Yu Sufu·Rouzi,Wang Yunling,Wang Hong,et al. DCE-MRI in differential diagnosis of liver lesions[J]. Journal of China Clinic Medical Imaging,2015,26(4):260-263.[玉苏甫·肉孜,王云玲,王红,等. DCE-MRI鉴别肝脏占位性病变的研究[J].中国临床医学影像杂志,2015,26(4):260-263.]
[13]Guo TC,Wu CY,Wen YX,et al. Sesonance enhanced imaging in differentiating liver cirrhosis nodules and the clinical application of small liver cancer research[J]. Chinese Journal of CT and MRI,2015,13(10):63-65.[郭天畅,伍彩云,温运雄,等.普美显磁共振增强成像在鉴别肝硬化结节与小肝癌的临床应用研究[J].中国CT和MRI杂志,2015,13(10):63-65.]
[14]Fang WL,Yang QY,Zhai JC,et al. Application of Gd-EOBDTPA enhanced MRI in the early imaging diagnosis of hepatocellular carcinoma[J]. Hainan Medical Journal,2017,28(3):432-434.[方文亮,杨秋云,翟建春,等.普美显MRI在肝癌早期影像诊断中的应用[J].海南医学,2017,28(3):432-434.]
[15]Joo I,Lee JM,Lee DH,et al. Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI:Can hypointensity on the hepatobiliary phase be used as an alternative to washout[J]? European Radiology,2015,25(10):2859-2868.
[16]Guo XC,Wang H,Wang K,et al. Recognition rate of the MDCT imaging features of hepatocellular carcinoma in cirrhotic liver:Based on LI-RADS(v2014)definition[J]. Radiologic Practice,2016,31(4):300-302.[郭小超,王鹤,王可,等.肝硬化背景下肝细胞癌的CT动态增强表现:LI-RADS(2014版)定义征象的出现率[J].放射学实践,2016,31(4):300-302.]
[17]Xie YH,Yu YQ,Qian YF,et al. The value of DWI in differentiating hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Journal of Clinical Radiology,2016,35(6):887-890.[谢玉海,余永强,钱银锋,等.扩散加权成像在鉴别肝细胞肝癌和周围型胆管细胞癌中的价值[J].临床放射学杂志,2016,35(6):887-890.]
[18]Chen YH,Lu J,Miu XF,et al. The value of DWI and ADC in the diagnosis of small liver cancer[J]. Jiangsu Medical Journal,2016,42(1):94-96.[陈月华,陆健,缪小芬,等.弥散加权成像及其表观弥散系数诊断小肝癌的价值[J].江苏医药,2016,42(1):94-96.]
[19]Yan YW,Rao SX,Yu MY. Value of ADC value for prediction of microvascular invasion of hepatocellular carcinoma[J]. Journal of Clinical Radiology,2016,35(1):93-95.[晏耀文,饶圣祥,俞梦勇.扩散加权成像在预测肝细胞肝癌微血管浸润的价值[J].临床放射学杂志,2016,35(1):93-95.]
[20]Zhang K,Li XB,Ma JX,et al. The correlation between the minimum and average ADC values of hepatocellular carcinoma and pathological grade[J]. Journal of Clinical Radiology,2016,35(5):728-731.[张坤,李绪斌,马菊香,等.肝细胞肝癌肿瘤ADC值与病理分级的相关性研究[J].临床放射学杂志,2016,35(5):728-731.]
[21]Ma XH,Wang S,Zhao XM,et al. The predictive value of IVIMDWI on short-term therapeutic effect and prognosis of TACE on hepatocellular carcinoma[J]. Chinese Journal of Magnetic Resonance Imaging,2017,8(04):248-253.[马霄虹,王爽,赵心明,等.体素内不相干运动扩散加权成像对肝癌经导管肝动脉化疗栓塞治疗短期疗效预测及评估的价值[J].磁共振成像,2017,8(04):248-253.]
[22]Hicks RM,Yee J,Ohliger MA,et al. Comparison of diffusionweighted imaging and T2-weighted single shot fast spin-echo:Implications for LI-RADS characterization of hepatocellular carcinoma[J]. Magnetic Resonance Imaging,2016,34(7):915-921.
[23]Li XJ,Meng XY,Chen X,et al. The diagnostic value of intravoxel incoherent motion diffusion-weighted imaging in evaluating hepatic lesions[J]. Radiologic Practice,2016,31(6):526-530.[李晓娟,孟晓岩,陈晓,等.体素内不相干运动磁共振扩散加权成像诊断肝脏占位性病变[J].放射学实践,2016,31(6):526-530.]
[24]Granata V,Fusco R,Catalano O,et al. Intravoxel incoherent motion(IVIM)in diffusion-weighted imaging(DWI)for hepatocellular carcinoma:Correlation with histologic grade[J]. Oncotarget,2016,7(48):79357-79364.
[25]Yang FH,Pu FS,Luo JB,et al. The application value of magnetic resonance enhancement combined with DWI in the diagnosis of liver tumor[J]. Modern Medical Imageology,2015,24(3):470-471.[杨富辉,普福顺,罗家滨,等.磁共振增强联合DWI技术在肝脏肿瘤诊断中的应用价值[J].现代医用影像学,2015,24(3):470-471.]
[26]Miao H,Zhao R,Ma X,et al. The diagnostic value of DWI combined dynamic contrast enhanced MRI in focal hepatic lesions[J]. China Practical Medicine,2017,12(8):98-99.[苗红,赵蕊,马茜,等. DWI联合磁共振动态增强扫描在肝脏局灶性占位病变的诊断价值[J].中国实用医药,2017,12(8):98-99.]
[27]Yuan WJ,Liu YT,Luo SB,et al. The clinical application value of DWI combined with GRE/T2W*multi-echo magnetic resonance imaging and serum AFP as well as carcinoembryonic antigen in evaluation of benign and malignant occupying lesions of liver[J].Journal of Medical Imaging,2015,25(10):1831-1835.[袁维军,刘永泰,骆世兵,等.磁共振DWI联合GRE/T2W*多回波技术与血清AFP联合癌胚抗原评估肝脏良恶占位性病变临床应用价值[J].医学影像学杂志,2015,25(10):1831-1835.]