CT、MR功能成像对肝脏恶性病变之间的鉴别诊断价值比较

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摘要目的：探讨并比较CT灌注、MR灌注及MR扩散加权成像（DWI）3种功能成像对肝脏恶性病变之间的鉴别诊断价值。方法：3组患者共39例进行了DWI成像、CT和MR灌注成像。肝细胞癌15例，胆管细胞癌11例，转移癌13例（来源于结肠癌6例，胃癌3例，胰腺癌4例）。DWI扫描，计算各例肝脏或病灶的ADC值并进行组间比较。CT、MR灌注成像，以脾脏的峰值时间为界，分别计算脾脏峰值前后肝脏和病灶的曲线最大斜率，以脾峰值前后两个斜率的比值作为评估指标进行组间对比。记为[SSr（ct）=SS前/SS后]和[SSr（mr）=SS前/SS后]。结果：肝细胞癌和转移瘤的ADC值[分别为（1.04±0.13）×10-3mm2/s和（1.11±0.19）×10-3mm2/s]都明显低于胆管细胞癌[（1.33±0.27）×10-3mm2/s]，差异有统计学意义（P<0.05），但肝细胞癌和转移瘤之间无统计学差异（P=0.424）。肝细胞癌组SSr（ct）和SSr（mr）测量结果分别为2.46±0.34和3.09±0.77，胆管细胞癌SSr（ct）和SSr（mr）平均值分别为1.03±0.21和1.12±0.21，转移组SSr（ct）和SSr（mr）平均值分别为0.94±0.29和0.99±0.37，胆管细胞癌组、转移组分别与肝细胞癌组之间，SSr（ct）和SSr（mr）都有显著统计学差异（P<0.05），前两组数值明显小于肝细胞癌组；胆管细胞癌与转移癌两组之间，SSr（ct）和SSr（mr）均无明显统计学差异（P>0.05）。结论：对肝细胞癌和转移癌分别与胆管细胞癌的鉴别，DWI成像比灌注成像更有优势；而在肝细胞癌和转移癌的鉴别上，CT、MR灌注提供的信息较DWI成像的ADC值的比较更有优势。

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	史丽静
	郭勇
	林伟
	张燕群
	郑奎洪
	黄敏华
	钱明珠
	王建和

关键词 ：癌, 肝细胞, 胆管肿瘤, 磁共振成像, 弥散, 体层摄影术, X线计算机

Abstract：Objective: To assess and compare the differential diagnostic value of CT perfusion, MR perfusion and DWI in different kinds of malignant liver lesions. Methods: Thirty-nine patients underwent CT perfusion, MR perfusion and DWI scan. They were divided into 3 groups: 15 hepatocellular carcinoma, 11 cholangioma, 13 metastasis tumor. Calculate the ADC value of each case and compare the results of the 3 groups. When CT perfusion and MR perfusion was finished, separate the perfusion curve of liver lesion and hepatic parenchyma into two parts according to the TTP of spleen, calculate the SS of each part, then get the ratio of the two SS, named [SSr(ct)=SSpre/SSpost] to CT perfusion and [SSr(mr)=SSpre/SSpost] to MR perfusion. Then compare SSr(ct) and SSr(mr) of the 3 groups. Results: The ADC value of hepatocellular carcinoma, cholangioma and metastasis tumor was (1.04±0.13)×10-3mm2/s, (1.33±0.27)×10-3mm2/s, and (1.11±0.19)×10-3mm2/s, respectively. The results of cholangioma were significantly higher than hepatocellular carcinoma and metastatic tumor(P<0.05), but the difference between hepatocellular carcinoma and metastatic tumor was not significant(P=0.424). The SSr(ct) and SSr(mr) of the 3 groups were: 2.46±0.34 and 3.09±0.77, 1.03±0.21 and 1.12±0.21, 0.94±0.29 and 0.99±0.37. The results of metastatic tumor was significantly lower than those of hepatocellular carcinoma(P<0.05), either of the difference between hepatocellular carcinoma or cholangioma(P<0.05). The difference between metastatic tumor and cholangioma was not significant(P>0.05). Conclusion: To the differential diagnosis of hepatocellular carcinoma and metastasis tumor from cholangioma, DWI has advantage than CT perfusion and MR perfusion. While the perfusion evaluation of CT and MR has more advantage in the diagnosis of hepatocellular carcinoma and metastatic tumor.

Key words： Carcinoma hepatocellular Bile duct neoplasms Diffusion magnetic resonance imaging Tomography X-ray computed

收稿日期: 2009-07-31

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引用本文:

史丽静;郭勇;林伟;张燕群;郑奎洪;黄敏华;钱明珠;王建和. CT、MR功能成像对肝脏恶性病变之间的鉴别诊断价值比较[J]. , 2010, 21(3): 175-178.
SHI Li-jing;GUO Yong;LIN Wei;ZHANG Yan-qun;ZHENG Kui-hong;HUANG Min-hua;QIAN Ming-zhu;WANG Jian-he. Comparison of the value of CT perfusion, MR perfusion and DWI in the differential diagnosis of malignant liver lesions. , 2010, 21(3): 175-178.

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http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2010/V21/I3/175