摘要
目的分析布加综合征(BCS)患者肝脏良性结节与肝细胞癌病灶的MRI鉴别诊断要点。方法回顾性分析2011年1月至2018年6月徐州医科大学附属医院连续收治的130例BCS患者资料,男性67例,女性63例,年龄范围18~78岁,中位年龄46岁。其中,肝细胞癌45例,良性结节85例。比较肝细胞癌与良性结节BCS患者的临床特征。比较肝细胞癌病灶与良性结节的MRI特征(大小、包膜、平扫信号、强化方式等)。受试者工作特征(ROC)曲线评估各指标诊断肝细胞癌的效能。结果合并良性结节的BCS患者年龄、甲胎蛋白低于合并肝细胞癌的BCS患者,国际标准化比值高于合并肝细胞癌的BCS患者,差异均有统计学意义(均P<0.05)。130例BCS患者有良性结节337个,肝细胞癌病灶78个。良性结节直径小于肝细胞癌病灶,良性结节有包膜、囊变坏死、出血比例低于肝细胞癌病灶,差异均有统计学意义(均P<0.05)。良性结节T1加权成像高信号、T2加权成像(T2WI)低或等信号、弥散加权成像(DWI)等信号比例高于肝细胞癌病灶,差异均有统计学意义(均P<0.05)。良性结节门静脉期或延迟期对比剂冲洗(washout)、动脉期明显强化+washout比例低于肝细胞癌病灶,差异均有统计学意义(均P<0.05)。DWI高信号以及T2WI高信号诊断肝细胞癌的ROC曲线下面积分别为0.936和0.927,灵敏度96.2%、92.3%,特异度91.0%、90.1%。结论BCS患者肝脏良性结节与肝细胞癌的MRI特征明显不同,washout征象对BCS患者肝细胞癌的诊断特异度较低。
Objective To compare MRI characteristics between hepatic benign nodules and hepatocellular carcinoma(HCC)associated with Budd-Chiari syndrome(BCS).Methods A retrospective study was conducted on 130 consecutive patients with BCS who were treated at the Affiliated Hospital of Xuzhou Medical University from January 2011 to June 2018.There were 67 males and 63 females,age ranged from 18 to 78 years,with median age was 46 years.There were 45 patients with HCC and 85 patients with benign liver nodules.This study aimed to compare the clinical characteristics of BCS patients with HCC and benign nodules,and to compare the MRI features(distribution,capsule,plain scan signal,enhancement pattern)between HCC and benign nodules.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of each of the indicators in the diagnosis of hepatocellular carcinoma.Results The age and alpha-fetoprotein levels of the BCS patients with benign nodules were significantly lower than the BCS patients with HCC,while the international standardized ratio was significantly higher than the BCS patients with HCC(all P<0.05).Of the 130 BCS patients,there were 337 benign and 78 hepatocellular carcinomas nodules.The diameter of benign nodules was significantly smaller than HCC,and the proportions of benign nodules with encapsulation,fat content,cystic necrosis and hemorrhage were significantly lower than HCC(all P<0.05).The proportions of benign nodules with T1 weighted imaging high signal,T2 weighted imaging(T2WI)low or equal signal and diffusion-weighted imaging(DWI)equal signal were significantly higher than HCC(all P<0.05).The proportions of benign nodules with washout appearance,arterial phase hyperenhancement and washout appearance were significantly lower than HCC(all P<0.05).The areas under the ROC curve for the diagnosis of HCC by DWI high signal and T2WI high signal were 0.936 and 0.927,respectively,with sensitivities of 96.2%and 92.3%,specificities of 91.0%and 90.1%,respectively.Conclusion The MRI features of BCS patients with benign regenerative nodules were significantly different from those of BCS patients with HCC.The washout appearance had a low specificity for the diagnosis of HCC.
作者
周德兴
孔莹
李磊
陈柱典
黄敏
徐凯
Zhou Dexing;Kong Ying;Li Lei;Chen Zhudian;Huang Min;Xu Kai(Department of Imaging,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2020年第7期539-542,共4页
Chinese Journal of Hepatobiliary Surgery
基金
江苏省科技厅社会发展面上项目(BE2017637)
江苏省医学影像创新团队领军人才(CXTDA2017028)。
