高场磁共振弥散加权成像对肝脏良恶性病变的鉴别诊断价值

目的通过3．0T磁共振弥散加权成像（DWI）以及ADC值的测量，分析肝脏占位性病变的DwI图像表现以及ADc值范围，探讨其成像特征及诊断价值。材料与方法收集内蒙古医学院附属医院2010年1月至2012年3月肝脏占位性病变（原发性肝癌、肝转移瘤、肝血管瘤、肝囊肿、肝局灶性结节增生及肝脓肿）患者153例，共296个病灶。每位患者均在3．OT磁共振扫描仪上行肝脏常规成像、选取不同b值（b=500S／illm2、b=1000S／mm2、b=1500S／mm0）DWI成像及高分辨T2加权成像．另外，对原发性肝癌、肝转移瘤患者每一病灶及病灶对侧正常肝组织分别取三个感兴趣区（ROI），尽量避开血管及液化坏死区测量ADC值，取其平均值使用t检验进行比较。结幂使用低b值（b=500S／him。）时，肝脏各种占位性病变的ADC值差异有统计学意义（P〈0．05）：中b值（b=l000S／mm2）及高b值（b=l500S／mm2）时，肝脏良、恶性病变的ADc值差异有统计学意义（P〈0．O5）；另外，高b值时肝癌和肝转移瘤的ADC值与正常肝组织的ADC值之比差异有统计学意义（P〈0．05）。结论通过比较肝脏占位性痛变的DWI图像特点及ADC值的不同范围，可准确的判断病变的性质，对肝脏占位性病变的良、恶性判断有较大的价值，瘤／肝比对原发性肝癌及肝转移瘤的鉴别具有一定意义。

The Differential Diagnosis Value of Diffusion Weighted Imaging in the Hepatic Lesions

Objective To analyze the liver space-occupying lesions of the DWI image and ADC range by taking the diffusion weighted imaging （ DWI ） and measuring the Apparent diffusion coefficient （ADC） worth, and to discusse the DWI imaging features and diagnos- tic values. Materials and Methods Collecting the patients from the Affiliated Hospital of Inner Mongolia Medical College in January 2010 to March 2012. All patients took MR scan in 3.0T equipment, including the conventional scan, the diffusion-weighted imaging （ DWI） and the high resolution T2 weighted imaging, each patient take DWI scan in three different b values （B = 500s /mm~, B = 1000s/mm2, B = 1500s / ram2）. The lesions and normal liver tissues under different b values and ADC values were compared by taking the t-test analyses. Results Using the small B value（B = 500s / ram＇- ） ,the different ADC v~dues of liver lesions were statistically significant （ P 〈 0.05 ）： Using the medium or high B value （B = 1000s /mm2 or B = 1500s /mm2）, the ADC values of benign and malignant lesions were statistically significant （ P 〈 0.05）.On the other hand, when using the high B value, the ADC value and ADC value ratio of the hepatocellular carcinoma and the liver metastases were statistically significant （ P 〈 0.05 ）. Conclusion Through the application of DWI imaging and ADC value measurement, the different liver lesions can be judged more accu- rately because of the different DWI characteristics of each disease.