摘要
目的探讨肝脏核磁共振(MRI)检查在高度异型增生结节(high-grade dysplastic nodules,HGDN)与早期肝细胞癌(hepatocellular carcinoma,HCC)肿瘤组织鉴别诊断的应用价值,为病人的早期筛检及个性化防治方案的制定提供参考依据。方法于2016年4月-2017年11月采用定群抽样法选取湖北省汉川市人民医院经病理活检确诊为HGDN与或早期HCC的患者共110例,在征得受试者知情同意的基础上对受试者进行MRI系列检查,采用χ^2检验或Fisher确切概率法对各检测结果的阳性率进行比较,采用ROC受试者特征曲线初步评估MRI在HGBN及早期HCC诊断中的敏感性和特异性。结果病理活检结果定性为HGDN的52例患者中,结节的检出率达96.97%(128/132),病理活检结果定性为早期HCC的58例患者中,结节的检出率达97.70%(85/87);以病理活检结果为金标准的ROC曲线的结果显示,MRI检查在HGBN及早期HCC诊断中的诊断价值较好(曲线下面积分别为0.834和0.846,二者均大于优质诊断标准的临界值0.6)。HGDN组T1WI的低信号所占比例最高,其次为等信号,同时只有极少比例的高信号病例存在;HCC组则可见T1WI的高信号所占比例最高,等信号和低信号的检出比例都非常少。2组T1WI信号特征差异有统计学意义(P<0.05)。HGDN组T2WI的高信号所占比例最高,其次为等信号,只有极少比例的低信号病例存在;HCC组则在T2WI的分布则为高信号所占比例最高,等信号和低信号的检出比例很少;2组T1WI信号特征差异有统计学意义(P<0.05)。此外,HGDN组动脉期的高信号所占比例最高,其次为等信号,极少比例为低信号;HCC组则表现出高信号所占比例最低,等信号和高信号的检出比例都很少,2组动脉期信号特征差异有统计学意义(P<0.05)。结论HGBN及早期HCC组患者均可见T1WI、T2WI、动脉期信号强度存在差别,T1WI、T2WI、动脉期不同信号强度对HGDN与早期HCC有鉴别诊断的价值;MRI检查不仅在筛检HGDN以及HCC具有较好应用价值,同时对于HGDN以及HCC的进一步鉴别也具有较好的分辨能力,在临床上能达到与病理活检基本持平的筛检能力,二者并用可能对患者的病情具有更好的提示价值。
Objective To explore the applicability of liver magnetic resonance imaging(MRI)in the differential diagnosis of HGDN and early HCC tumor tissues, and to provide reference for the early screening and individualized prevention and treatment of patients. Methods Between April 2016 and November 2017, 110 patients were diagnosed with HGDN and early HCC by pathological biopsy using a group sampling method. The subjects gave the informed consent before the MRI series of tests. The positive rate of each test was compared by χ^2 test or Fisher exact probability. The sensitivity and specificity of MRI in the diagnosis of HGBN and early HCC were evaluated by the ROC receiver characteristic curve. Results Among the 52 subjects whose pathological biopsy results were qualitatively HGDN, the detection rate of nodules was 96.97%(128/132). The pathological biopsy results were identified as 58 cases of early HCC. The detection rate of nodules was up to 97.70%(85/87). The results of the ROC curve with pathological biopsy results as the gold standard showed that MRI examination was of better diagnostic value in HGBN and early HCC diagnosis(the area under the curve was 0.834 and 0.846, respectively). The critical value of the diagnostic criteria was 0.6, and the sensitivity and specificity were basically at a high level. In the HGDN group, the low signal rate of T1WI was the highest, followed by equal signals, and only a small proportion of high signals was detected. In the HCC group, the high signal rate of T1WI was the highest, and quite few equal signals or low signals were detected. There were differences in the characteristics of the T1WI signals in the 2 groups, and the difference was statistically significant(P<0.05). In the HGDN group, T2WI had the highest proportion of high signals, followed by equal signals, and only a small number of cases of low signals were detected. In the HCC group, the proportion of low signals of T2WI was the highest, while the proportion of equal signals and high signals was small. There were differences in the characteristics of the T2WI signals in the 2 groups, and the difference was statistically significant(P<0.05). In addition, the HGDN group had the highest proportion of high signals in the arterial phase, followed by equal signals, and the lowest proportion was with low signals. The HCC group had the highest proportion of low signals, and the detection rate of equal signals and high signals was very low. There were differences in the signal characteristics of the arterial phase between the two groups, and the difference was statistically significant(P<0.05). Conclusion The HGDN and early HCC patients show different signal intensities in T1WI, T2WI, and arterial phase, and the difference is statistically significant. MRI not only is effective for screening HGDN and HCC, but also can help the identification of HGDN and HCC. It is clinically as effective for screening as pathological biopsy.
作者
刘远高
李杰平
付哲祥
吕志强
李昌松
LIU Yuangao;LI Jieping;FU Zhexiang;LV Zhiqiang;LI Changsong(Department of Radiology, People's Hospital of Hanchuan City,Hanchuan Hubei 431600, China)
出处
《空军医学杂志》
2019年第3期225-228,共4页
Medical Journal of Air Force
关键词
高度异型增生结节
肝细胞癌
MRI
鉴别诊断
价值评估
highly atypical hyperplasia nodules
hepatocellular carcinoma
MRI
differential diagnosis
valuation
