磁共振成像扩散加权成像技术在鉴别原发性胆囊癌和肝细胞癌中的价值

目的 探讨MRI扩散加权成像(DWI)技术对侵犯肝脏的原发性胆囊癌和侵犯胆囊的原发性肝细胞癌进行鉴别诊断的价值.方法 回顾性分析2009年1月至2010年10月解放军总医院收治的11例原发性胆囊癌和19例原发性肝细胞癌患者的临床资料.采用MRI DWI技术对两种疾病进行鉴别诊断.选择扩散敏感梯度场参数(b值)为800 s/mm2时进行扫描,绘制受试者工作特征曲线(ROC),比较原发性肝细胞癌和原发性胆囊癌的表观弥散系数(ADC)阈值.利用独立样本t检验比较两组ADC值之间的差异.结果 30例患者共30个肿瘤,所有肿瘤在DWI图像上呈高信号,T1WI呈稍低信号,T2WI呈稍高信号,原发性胆囊癌累及肝脏的边界欠清楚.11例原发性胆囊癌患者的肿瘤主要位于胆囊窝区,其中10例累及肝脏,平均ADC值为(0.89±0.14)mm2/s;19例原发性肝细胞癌患者中,15例肿瘤位于肝右叶,4例肿瘤位于肝左叶,平均ADC值为(1.04±0.18)mm2/s,两者ADC值比较,差异有统计学意义(t=2.425,P＜0.05).ROC曲线下面积为0.756(95%CI:0.577～0.935),当阈值为0.96 mm2/s时,敏感性为68.4%,特异性为81.8%.结论 b值为800 s/mm2时,原发性胆囊癌的ADC值低于原发性肝细胞癌,有利于两种疾病的鉴别诊断.

Abstract：

Objective To investigate the value of diffusion-weighted magnetic resonance imaging in the differential diagnosis of primary gallbladder cancer with liver invasion and primary hepatocellular carcinoma (HCC) with gallbladder invasion. Methods From January 2009 to October 2010, 11 patients with primary gallbladder cancer and 19 patients with primary HCC were admitted to the PLA General Hospital. The clinical data of the 30 patients were retrospectively analyzed. All patients underwent diffusion-weighted magnetic resonance imaging with b value of 800 s/mm2, and the receiver operating curve (ROC) was drawn. The apparent diffusion coefficient (ADC) values of the patients with gallbladder cancer and HCC were compared by independent sample t test. Results Thirty tumors were detected in the 30 patients. All tumors showed high signal on DWI, slightly low signal on T1 WI and slightly high signal on T2 WI. The foci of 11 patients with primary gallbladder cancer were at the gallbladder fossa, and 10 of them had liver involvement. The mean ADC value of the 11 patients was (0.89 ±0. 14)mm2/s. Of the 19 patients with primary HCC, the foci of 15 patients were at the right lobe of liver, and 4were at the left lobe. The mean ADC value of the 19 patients was (1.04 ±0.18)mm2/s. There was a significant difference in the ADC value between patients with primary gallbladder cancer and those with primary HCC ( t =2.425, P＜0. 05). The area under the ROC was 0. 756 (95% confidence interval: 0.577-0. 935), and the sensitivity and specificity were 68.4% and 81.8%, respectively, when the threshold value was 0.96 mm2/s.Conclusion The ADC value of patients with primary gallbladder cancer is lower than those with primary HCC when the b value is 800 s/mm2, which is helpful in the differential diagnosis of primary gallbladder cancer and primary HCC.

Value of diffusion-weighted magnetic resonance imaging in differential diagnosis of primary gallbladder cancer and hepatocellular carcinoma

Objective To investigate the value of diffusion-weighted magnetic resonance imaging in the differential diagnosis of primary gallbladder cancer with liver invasion and primary hepatocellular carcinoma (HCC) with gallbladder invasion. Methods From January 2009 to October 2010, 11 patients with primary gallbladder cancer and 19 patients with primary HCC were admitted to the PLA General Hospital. The clinical data of the 30 patients were retrospectively analyzed. All patients underwent diffusion-weighted magnetic resonance imaging with b value of 800 s/mm2, and the receiver operating curve (ROC) was drawn. The apparent diffusion coefficient (ADC) values of the patients with gallbladder cancer and HCC were compared by independent sample t test. Results Thirty tumors were detected in the 30 patients. All tumors showed high signal on DWI, slightly low signal on T1 WI and slightly high signal on T2 WI. The foci of 11 patients with primary gallbladder cancer were at the gallbladder fossa, and 10 of them had liver involvement. The mean ADC value of the 11 patients was (0.89 ±0. 14)mm2/s. Of the 19 patients with primary HCC, the foci of 15 patients were at the right lobe of liver, and 4were at the left lobe. The mean ADC value of the 19 patients was (1.04 ±0.18)mm2/s. There was a significant difference in the ADC value between patients with primary gallbladder cancer and those with primary HCC ( t =2.425, P＜0. 05). The area under the ROC was 0. 756 (95% confidence interval: 0.577-0. 935), and the sensitivity and specificity were 68.4% and 81.8%, respectively, when the threshold value was 0.96 mm2/s.Conclusion The ADC value of patients with primary gallbladder cancer is lower than those with primary HCC when the b value is 800 s/mm2, which is helpful in the differential diagnosis of primary gallbladder cancer and primary HCC.