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中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 189 -194. doi: 10.3877/cma.j.issn.1674-0793.2020.03.006

所属专题: 文献

论著

磁共振弥散峰度成像在鉴别肝细胞癌与其他良性结节中的价值
黄泽弟1, 王猛2, 沈冰奇2,(), 李思聪1   
  1. 1. 518102 深圳市宝安区中心医院(深圳大学附属第五医院)放射科
    2. 510080 广州,中山大学附属第一医院放射诊断科
  • 收稿日期:2020-02-25 出版日期:2020-06-01
  • 通信作者: 沈冰奇

Eiffcacy of diffusion kurtosis MR imaging for distinguishing hepatocellular carcinoma from benign hepatic nodules

Zedi Huang1, Meng Wang2, Bingqi Shen2,(), Sicong Li1   

  1. 1. Department of Radiology, Central Hospital of Baoan District, the Fifth Affiliated Hospital of Shenzhen University, Shenzhen 518102, China
    2. Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2020-02-25 Published:2020-06-01
  • Corresponding author: Bingqi Shen
  • About author:
    Corresponding author: Shen Bingqi, Email:
引用本文:

黄泽弟, 王猛, 沈冰奇, 李思聪. 磁共振弥散峰度成像在鉴别肝细胞癌与其他良性结节中的价值[J/OL]. 中华普通外科学文献(电子版), 2020, 14(03): 189-194.

Zedi Huang, Meng Wang, Bingqi Shen, Sicong Li. Eiffcacy of diffusion kurtosis MR imaging for distinguishing hepatocellular carcinoma from benign hepatic nodules[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(03): 189-194.

目的

研究磁共振弥散峰度成像(DKI)在鉴别肝细胞癌(HCC)与其他肝脏良性结节中的价值。

方法

回顾性收集中山大学附属第一医院收治的112例肝脏原发肿瘤患者的临床资料,共计150个肝脏结节,根据病理结果分为良性结节组(56个,包括局灶性结节增生26个、血管瘤24个、肝腺瘤6个)和HCC组(HCC 94个)。所有患者均行DKI(b=0、50、200、400、800、2 000 s/mm2)成像,计算不同模型参数值:扩散率(D)、峰度(K)和单指数模型表观扩散系数(ADC)。采用Logistic回归和受试者工作特征(ROC)曲线来比较各参数鉴别HCC与其他肝脏良性结节的诊断效能。

结果

HCC组ADC、D、K值中位数(四分位数间距)分别为1.172(0.389) ×10-3 mm2/s、1.751(0.759)×10-3 mm2/s、0.013(0.315),良性结节组分别为1.670(0.675)×10-3 mm2/s、2.510(1.186)×10-3 mm2/s、0.162(0.223),两组间差异均有统计学意义(均P<0.001)。ADC、D、K值鉴别HCC与其他肝脏良性结节的曲线下面积分别为0.815、0.779和0.722,截断值分别为1.238×10-3 mm2/s、1.881×10-3 mm2/s和0.056,敏感度、特异度及准确性分别为87.5%、59.6%、76.7%(ADC),83.9%、62.8%、76.0%(D)和75.0%、60.6%、70.0%(K)。

结论

DKI参数值D、K及常规扩散加权成像参数值ADC均可以用于鉴别HCC与局灶性结节增生、血管瘤及肝细胞腺瘤,ADC值的敏感度、特异度及准确性高于D、K值。

Objective

To assess the value of diffusion kurtosis imaging (DKI) in distinguishing hepatocellular carcinoma (HCC) from other benign hepatic nodules.

Methods

According to the pathological results, 150 hepatic nodules of 112 patients from the First Affiliated Hospital of Sun Yat-sen University were divided into two groups: benign group (26 of focal nodular hyperplasia, 24 of hemangioma, 6 of hepatocellular adenoma) and malignant group (94 of HCC). Preoperative MRI examinations including DKI (b values: 0, 50, 200, 400, 800 and 2 000 s/mm2) were performed. Apparent diffusion coefficient (ADC) and DKI-derived parameters such as diffusivity values (D), kurtosis values (K) were analyzed by Logistic regression and receiver operating characteristic (ROC) curve to evaluate their efficacy for distinguishing HCC from benign hepatic nodules.

Results

The median (interquartile range) values of ADC, D and K of malignant group were 1.172(0.389)×10-3 mm2/s, 1.751(0.759)×10-3 mm2/s, and 0.013(0.315), while those of benign group were 1.670(0.675)×10-3 mm2/s, 2.510(1.186)×10-3 mm2/s and 0.162(0.223), respectively. There were statistically significant differences in ADC, D and K between the two groups(all P<0.001). The area under the curve of ADC, D, and K to identify HCC and liver benign nodules were 0.815, 0.779, and 0.722, and the optimal cut-off values were 1.238×10-3 mm2/s, 1.881×10-3 mm2/s, 0.056, the sensitivity, specificity and accuracy were 87.5%, 59.6%, 76.7% (ADC) ; 83.9%, 62.8%, 76.0% (D); 75.0%, 60.6%, 70.0% (K), respectively.

Conclusions

DKI parameter values D, K and conventional DWI parameter value ADC can be used to distinguish HCC from focal nodular hyperplasia, hemangioma and hepatocellular adenoma. The sensitivity, specificity and accuracy of ADC are higher than D and K.

表1 MRI扫描序列及参数
图1 HCC最大层面感兴趣区绘制(绿色圆圈) A、B为轴位T2WI压脂、T1WI;C~E为动态增强成像动脉期、门静脉期和肝胆特异期;F、G为肝轴向扩散加权成像(diffusion-weighted imaging, DWI,b=800 s/mm2)和ADC图;H~J为轴向肝DKI成像(b=2 000 s/mm2)、DKI参数K图、D图
图2 FNH最大层面感兴趣区绘制(绿色圆圈) A、B为轴位T2WI压脂、T1WI;C~E为动态增强成像动脉期、门静脉期和肝胆特异期;F、G为肝轴向DWI成像(b=800 s/mm2)和ADC图;H~J为轴向肝DKI成像(b=2 000 s/mm2)、DKI参数K图、D图
图3 血管瘤最大层面感兴趣区绘制(绿色圆圈) A、B为轴位T2WI压脂、T1WI;C~E为动态增强成像动脉期、门静脉期和肝胆特异期;F、G为肝轴向DWI成像(b=800 s/mm2)和ADC图;H~J轴向肝DKI成像(b=2 000 s/mm2)、DKI参数K图、D图
图4 肝腺瘤最大层面感兴趣区绘制(绿色圆圈) A、B为轴位T2WI压脂、T1WI;C~E为动态增强成像动脉期、门静脉期和肝胆特异期;F、G为肝轴向DWI成像(b=800 s/mm2)和ADC图;H~J为轴向肝DKI成像(b=2 000 s/mm2)、DKI参数K图、D图
表2 两组磁共振弥散峰度成像参数值比较结果
图5 ADC、D、K鉴别肝细胞癌与其他肝脏良性结节的ROC曲线
表3 各参数鉴别HCC与其他肝脏良性结节的诊断效能
[1]
Lee JM, Yoon JH, Joo I, et al. Recent advances in CT and MR imaging for evaluation of Hepatocellular carcinoma[J]. Liver Cancer, 2012, 1(1): 22-40.
[2]
孙可欣, 郑荣寿, 张思维, 等. 2015年中国分地区恶性肿瘤发病和死亡分析[J]. 中国肿瘤, 2019, 28(1): 1-11.
[3]
Kim TK, Lee E, Jang HJ. Imaging findings of mimickers of hepatocellular carcinoma[J]. Clin Mol Hepatol, 2015, 21(4): 326-343.
[4]
Jensen JH, Helpern JA. MRI quantification of non-Gaussian water diffusion by kurtosis analysis[J]. NMR Biomed, 2010, 23(7): 698-710.
[5]
Agnello F, Ronot M, Valla DC, et al. High-b-value diffusion-weighted MR imaging of benign hepatocellular lesions: quantitative and qualitative analysis[J]. Radiology, 2012, 262(2): 511-519.
[6]
Yoshimura N, Saito K, Saguchi T, et al. Distinguishing hepatic hemangiomas from metastatic tumors using T1 mapping on gadoxetic-acid-enhanced MRI[J]. Magn Reson Imaging, 2013, 31(1): 23-27.
[7]
Taouli B, Koh DM. Diffusion-weighted imaging of the liver[J]. Radiology, 2010, 254(1): 47-66.
[8]
Parikh T, Drew SJ, Lee VS, et al. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging[J]. Radiology, 2008, 246(3): 812-822.
[9]
Sandrasegaran K, Akisik FM, Lin C, et al. The value of diffusion-weighted imaging in characterizing focal liver masses[J]. Acad Radiol, 2009, 16(10): 1208-1214.
[10]
Muhi A, Ichikawa T, Motosugi U, et al. High-b-value diffusion-weighted MR imaging of hepatocellular lesions: estimation of grade of malignancy of hepatocellular carcinoma[J]. J Magn Reson Imaging, 2009, 30(5): 1005-1011.
[11]
Falk Delgado A, Nilsson M, van Westen D, et al. Glioma grade discrimination with MR diffusion kurtosis imaging: A Meta-analysis of diagnostic accuracy[J]. Radiology, 2018, 287(1): 119-127.
[12]
Goshima S, Kanematsu M, Noda Y, et al. Diffusion kurtosis imaging to assess response to treatment in hypervascular hepatocellular carcinoma[J]. AJR Am J Roentgenol, 2015, 204(5): W543-W549.
[13]
Rosenkrantz AB, Sigmund EE, Winnick A, et al. Assessment of hepatocellular carcinoma using apparent diffusion coefficient and diffusion kurtosis indices: preliminary experience in fresh liver explants[J]. Magn Reson Imaging, 2012, 30(10): 1534-1540.
[14]
Ahlawat S, Fayad LM. Diffusion weighted imaging demystified: the technique and potential clinical applications for soft tissue imaging[J]. Skeletal Radiol, 2018, 47(3): 313-328.
[15]
Lewis S, Kamath A, Chatterji M, et al. Diffusion-weighted imaging of the liver in patients with chronic liver disease: comparison of monopolar and bipolar diffusion gradients for image quality and lesion detection[J]. AJR Am J Roentgenol, 2015, 204(1): 59-68.
[16]
Galea N, Cantisani V, Taouli B. Liver lesion detection and characterization: role of diffusion-weighted imaging[J]. J Magn Reson Imaging, 2013, 37(6): 1260-1276.
[17]
Dai Y, Yao Q, Wu G, et al. Characterization of clear cell renal cell carcinoma with diffusion kurtosis imaging: correlation between diffusion kurtosis parameters and tumor cellularity[J]. NMR Biomed, 2016, 29(7): 873-881.
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