多b值扩散加权成像联合DCE-MRI在小肝癌鉴别诊断中的应用

目的探讨多b值扩散加权成像(DWI)联合动态增强(DCE-MRI)在小肝癌(SHCC)鉴别诊断中的应用。方法收集2016年3月至2019年3月就诊于我院的临床疑似SHCC患者80例,均行常规MRI、DCE-MRI及多b值DWI检查,分别测量b值为20、60、100、400、600、800s/mm2时病灶的ADC值,并采用受试者工作特征(ROC)曲线分析ADC值对可疑SHCC的诊断价值。结果80例疑似SHCC患者,经手术病理或随访证实SHCC 54例,非SHCC 26例。当b值取20、60、100s/mm2等时,SHCC与非SHCC的ADC值比较无统计学差异(P>0.05);而当b值取400、600、800s/mm2时,SHCC的ADC值明显小于非SHCC(P<0.05)。ROC曲线分析显示,ADC值截断值≤1.26×10^-3mm²/s时,诊断敏感度为92.3%,特异度为91.1%,准确度为90.4%。DWI联合DCE-MRI诊断SHCC的特异度为88.46%,较单纯DCE-MRI(61.53%)明显提高,且敏感度仍保持在90%以上。结论多b值DWI对于可疑SHCC的诊断有重要作用,联合DCE-MRI有助于SHCC的鉴别诊断。

Application of Multi-b Values Diffusion-weighted Imaging Combined with DCE-MRI in Differential Diagnosis of Small Hepatocellular Carcinoma

Objective To explore application of multi-b values diffusion-weighted imaging(DWI)combined with dynamic contrast-enhanced MRI(DCE-MRI)in differential diagnosis of small hepatocellular carcinoma(SHCC).Methods 80 patients clinically suspected with SHCC treated in the hospital from March 2016 to September 2019 were enrolled.All underwent routine MRI,DCE-MRI and multi-b value DWI.ADC values of lesions when b values were 20,60,100,400,600 and 800 s/mm2 were measured.The receiver operating characteristic(ROC)curves were performed to analyze diagnostic value of ADC values for suspected SHCC.Results Of 80 patients suspected with SHCC,there were 54 cases with SHCC and 26 cases without SHCC confirmed by surgical pathology or follow-up.When b values were 20,60,and 100 s/mm2,there was no significant difference in ADC values between SHCC and non-SHCC(P>0.05).When b values were 400,600,and 800 s/m m2,ADC values of SHCC were significantly smaller than those of non-SHCC(P<0.05).ROC cu rve analysis showed that when cutoff value of ADC value was not greater than 1.26×10^-3mm²/s,diagnostic sensitivity,specificity,and accuracy were 92.3%,91.1%and 90.4%,respectively.The specificity of DWI combined with DCE-MRI for diagnosis of SHCC was88.46%,which was higher than DCE-MRI alone(61.53%).And sensitivity was above 90%.Conclusion Multi-b values DWI plays important roles in diagnosis of suspected SHCC.Its combination with DCEMRI is helpful fo r differential diagnosis of SHCC.