肝硬化结节恶变患者超声、CT、MRI的诊断价值分析

目的探讨肝硬化结节恶变患者超声、CT、MRI的诊断准确性及图像特征。方法随机选取我院2018年2月至2019年2月收治的肝硬化结节恶变患者93例为研究对象,分别接受超声、CT、MRI诊断及病理检查。比较三种影像学肝硬化结节恶变诊断结果、准确性,分析其影像学特征。结果三种影像学诊断肝硬化结节恶变阳性率差异比较有统计学意义(P<0.05),由高到低分别是MRI、CT、超声。三种影像学恶变肝硬化结节准确率比较有统计学意义(P<0.05),准确率由高到低依次是MRI、CT、超声。三种影像学恶变肝硬化结节漏诊率比较有统计学意义(P<0.05),由高到低依次是超声、CT、MRI。超声恶变结节中60.71%低回声,20.24%高回声,19.05%等回声。73.81%肝硬化恶变结节图像为圆形多边形,边界清晰。6.00%恶变结节周边伴有声晕或侧方声影,见彩色血流,其中33.33%恶变结节后方回声增强出现"中心高,四周低"的回声特征。CT肝硬化恶变结节中有79.57%占位为高密度,等密度8.60%,周围稍高密度9.68%,中心低密度2.15%。增强扫描发现动脉期肝内结节无明显增强,境界清楚。门脉期肝内结节与肝实质同步强化,境界模糊。MRI硬化恶变结节中有14.58%TiWI高信号,等信号31.58%,低信号50.00%。T2WI高信号88.60%,等信号3.51%,低信号7.90%。动态增强扫描"快进快出"81.58%,"快进慢出"9.65%,持续强化病灶8.78%。结论超声、CT、MRI均能检出肝硬化恶变结节,其中MRI检出率、准确率较高,漏诊少,建议使用MRI诊断肝硬化结节恶变情况。

Diagnostic Value of Ultrasound,CT and MRI in Patients with Malignant Transformation of Cirrhotic Nodules

Objective To investigate the diagnostic value of ultrasound,CT,and MRI in patients with malignant transformation of cirrhotic nodules.Methods 93 patients with malignant transformation of cirrhotic nodules in our hospital from February 20 to February 2019 were selected,and underwent ultrasound,CT,MRI,and pathological examinations.Then the diagnostic results,accuracy,and imaging cha racteristics of three imaging methods were recorded and compared.Results The positive diagnostic rates of malignant transformation of cirrhotic nodules among three methods ranking in descending order was MRI,CT,and ultrasound,with a statistical difference(P<0.05).The diagnostic accuracy rates of malignant transformation of cirrhotic nodules among three methods ranking in descending order were MRI,CT,and ultrasound,with a statistic difference(P<0.05).The missed diagnosis rates of malignant transformation of cirrhotic nodules among three methods ranking in ascending order were MRI,CT,and ultrasound,with a statistic difference(P<0.05).The ultrasound showed that the hypoechoic,hyperechoic,isoechoic nodules accounted for 60.71%,20.24%,and 19.05%,respectively.The image of 73.81%nodules was a circular polygon with clear boundary.Sonic or lateral sound shadows accompanied 6.00%nodules,and color blood flow was observed,among which 33.33%malignant nodules showed"high center,low around"echo enhancement.79.57%nodules discovered by CT showed high density,8.60%presented iso-intensity,9.68%showed slightly high density,and 2.15%showed low density.Enhanced scan showed that the nodules in the arterial phase did not increase significantly,and the bounda ry was clear.The nodules in portal vein phase and liver parenchyma were enhanced synchronously,and the boundary was blurred.T1WI manifested hyperintensity,isointensity,or hypointense in 14.58%,31.58%,and 50.00%nodules.T2WI manifested hyperintensity,isointensity,or hypointense in 88.60%,3.51%,and 7.90%nodules.Dynamic contrastenhanced scan showed 81.58%fast-in-fast-out,9.65%fast-in-slow-out and 8.78%continuous enhancement.Conclusion The malignant transformation of cirrhotic nodules can be detected by ultrasound,CT,and MRI,among which the detection rate and accuracy rate of MRI are relatively high,and the missed diagnosis was rare.Therefore,it is recommended to use MRI to diagnose malignant transformation of cirrhotic nodules.