DWI技术在肝脏占位性病变鉴别诊断中的价值

目的:探讨不同b值时表现扩散系数(ADC)值、指数化表现扩散系数(eADC)值、灌注ADC值和eADC值在肝脏常见占位性病变鉴别诊断中的价值。方法:对73例肝脏恶性肿瘤及40例良性占位性病变行磁共振扩散加权成像(DWI),并计算低、中和高b值时病灶的ADC值和eADC值及灌注ADC和eADC值。分析不同b值时各测量参数在不同病变之间的差异。结果:低、中b值时,在血管瘤与其他病变之间,局灶性结节增生(FNH)与转移瘤、肝脓肿之间,肝细胞癌(HCC)与肝脓肿之间,ADC和eADC值差异均具有统计学意义(P<0.05)。当高b值时,在血管瘤与HCC、肝内胆管细胞癌(CCC)及FNH之间,FNH与转移瘤、CCC、肝脓肿之间,肝脓肿与CCC之间,及转移瘤与HCC、CCC之间,ADC值和eADC值差异均具有统计学意义(P<0.05)。在血管瘤与其他病变之间,FNH与转移瘤、肝脓肿、CCC之间,肝脓肿与HCC之间灌注ADC和eADC值差异也具有统计学意义(P<0.05),灌注eADC值在HCC和CCC之间差异也具有统计学意义(P<0.05)。结论:灌注ADC和eADC值,恶性肿瘤采用高b值、良性病变采用低中b值得到ADC和eADC值有助于肝脏占位性病变的鉴别诊断。

The value of measured parameters of DWI in differential diagnosis on hepatic masses at 3.0 T

Objective: To investigate the value of the apparent diffusion coefficient (ADC) value and the exponential apparent diffusion coefficient (eADC) value with different b values,and the perfusion ADC (ADC_(perf)) and perfusion eADC (eADC_(perf)) values of magnetic resonance diffusion weighted imaging (DWD in differential diagnosis for common hepatic masses.Methods: DWI scanning was carried out on 73 patients with malignant liver tumors and 40 cases with benign hepatic masses.The ADC value and eADC value with low (100s/mm~2,200s/mm~2 and 300s/mm~2),moderate (400s/mm~2 and 600s/mm~2) and high (800 s/mm~2,1000 s/mm~2 and 1200 s/mm~2) b values were analyzed on the entire lesion.According to the difference in ADC and eADC values between low b value and high one,the perfusion ADC (ADC_(perf)) and perfusion eADC (eADC_(perf)) values were calculated.The differences in all measured parameters above with different b values between different lesions were analyzed. Results: Significant differences in ADC and eADC values of low and moderate b values were found between hemangioma and other 5 lesions,between focal nodular hyperplasias (FNH) and abscess or metastasis,between hepatocellular carcinomas (HCC) and abscess(P<0.05).There were also significant differences in ADC and eADC values of high b values between hemangioma and HCC,CCC or FNH,between FNH and CCC,metastasis or abscess,and between abscess and CCC (P<0.05).In addition, the differences in ADC_(Perf) and eADC_(perf) values between hemangioma and other 5 lesions,between FNH and CCC,metastasis or abscess,and between abscess and HCC,and difference in eADC_(perf) value between HCC and CCC were also significant (P<0.05).No differences were found between the HCC and the FNH,and between the metastasis and the abscess were gotten (P >0.05).Conclusion: The ADC and eADC values calculated from ADC_(perf) and eADC_(perf) with a high b value in malignant tumor,and with a low or moderate b value in benign mass are helpful for the differential diagnosis in hepatic masses.