多b值DWI在肝脏良恶性肿瘤鉴别诊断中的应用研究

目的：研究多b值DWI序列ADC值测量作为生物学标志物在肝脏良恶性肿瘤鉴别诊断中的价值.方法：选择经综合影像学检查及经穿刺病理证实的52例肝脏肿瘤患者（肝癌7例、肝转移瘤16例、肝血管瘤18例、肝囊肿11例）行多b值DWI扫描及常规MRI检查,分别计算ADClow、ADChigh、ADCperf、ADC3b及ADC10b值,分析肝脏良恶性肿瘤各ADC值之间的差异.建立受试者工作特征曲线（Receive operating characteristic curve,ROC）.结果：肝脏良恶性病变的ADChigh值之间存在统计学差异（P＜0.05）,而肝癌与肝转移瘤之间以及肝血管瘤与肝囊肿之间差异无统计学意义（P＞0.05）;肝脏良恶性病变之间的ADCperf值差异有统计学意义（P＜0.05）,而肝囊肿与肝血管瘤之间的ADCperf值差异无统计学意义（P＞0.05）;肝脏各组病变的ADC3b及ADC10b值之间存在统计学差异（P＜0.05）;肝脏不同肿瘤的ADClow值差异无统计学意义（P＞0.05）;ADC10b组以0.102×10-3 s/mm2为分界值鉴别良恶性的敏感性、特异性分别为96.6％、87％,ADC3b组以0.285×10-3 s/mm2为分界值则敏感性、特异性分别为93.1％、82.6％.结论：多b值DWI序列可通过多个定量参数从细胞代谢及血流灌注方面为肝脏良恶性肿瘤的鉴别提供诊断依据,其中ADC10b、ADC3b、ADChigh、ADCperf值对肝脏肿瘤定性诊断更具优势.

Application of multi-b-value DWI in the differential diagnosis of benign and malignant liver tumor

Objective： To study the value of multi-b-value DWI sequence and ADC value as biological markers in the differential diagnosis of benign and malignant tumors in the liver. Methods： Fifty-two patients with liver tumors confirmed by comprehensive imaging examination and biopsy （7 cases of liver cancer and liver metastases in 16 cases, liver hemangioma in 18 cases, 11 cases of hepatic cysts） were chosen to take DWI scan of multiple b values and conventional MRI. ADClow, ADChigh, ADCprcf, ADC3b and ADC10b value were calculated and difference between benign and malignant tumors was analyzed. The receiver-operating characteristic curve （receive operating characteristic curve, ROC） was established. Results： The difference of ADC value between benign and malignant liver lesions was significantly （P〈O.O5）, but the difference between liver cancer and liver metastases, liver hemangioma and liver cyst showed no statistical significance （P〉0.O5）. The ADC value of tumor between benign and malignant lesions had statistical difference （P〈0.05）, but no significant difference was found between benign tumors （P〉O.O5）. The ADC values of various liver diseases was statistically different with lOb and 3b （P〈0.05）. With b value of low, the ADC values of different liver tumors showed no statistical significance （P〉O.05）. The sensitivity, specificity were 96.6%, 87% and 93.1%, 82.6% respectively, when using a threshold ADC of less than 0.102x10-3 s/mm2, 0.285x10-3 s/mm/ in group of 10b and 3b, respectively. Conclusion： Multi-b-value DWI sequence can help in the identification of benign and malignant tumor diagnosis through multiple quantitative parameters from tumor microcirculation and cell metabolism of liver, especially the ADCI10b ADC3b, ADChigh and ADCperf values.