【摘要】 目的探讨磁共振动态增强(DCE-MRI)联合弥散加权成像(DWI)在原发性肝癌患者中的诊断效果及临床价值。方法回顾性选择2014年3月至2017年12月入院诊断的疑似原发性肝肿瘤患者57例作为对象。所有患者均经过手术病理检查得到确诊,手术前患者先行磁共振动态增强扫描,绘制病灶部位时间-信号曲线,然后对患者进行弥散加权成像检查,在b值=800时计算相应的表观弥散系数(ADC)值;记录并统计单一增强扫描与联合磁共振动态增强扫描时的灵敏性、特异度、准确性及阳性和阴性预测值。分析磁共振动态增强量和弥散加权成像在原发性肝癌患者中的诊断及价值。结果 57例疑似原发性肝肿瘤患者均经过手术病理检查最终得到确诊,其中原发性肝癌46例,肝脏海绵状血管瘤6例,肝囊肿5例。原发性肝癌患者ADC值低于肝血管瘤及肝囊肿(P<0.05);肝血管瘤ADC值低于肝囊肿(P<0.05);DCE-MRI联合DWI诊断最终确诊57例,与病理诊断符合率为100.00%;DCE-MRI最终确诊55例,与病理诊断符合率为96.49%;DCE-MRI联合DWI诊断灵敏度、特异度、准确度、阳性预测值及阴性预测值,均高于DCE-MRI(P<0.05)。结论将磁共振动态增强联合弥散加权成像用于原发性肝癌患者中有助于提高诊断符合率,获得较高的诊断效能,为临床提供影像学依据,值得推广应用。更多还原

【Abstract】 Objective To investigate the diagnostic effect and clinical value of dynamic contrast enhanced magnetic resonance imaging( DCE-MRI) combined with diffusion weighted imaging( DWI) in primary liver cancer patients. Methods A total of 57 patients suspected of having primary liver tumor diagnosed from March 2014 to December 2017 were selected as subjects. All patients were confirmed by surgical pathological examination. Before surgery,patients were subjected to dynamic contrast-enhanced magnetic resonance scanning to map the lesions. The time-signal curve was then used to perform diffusion-weighted imaging of the patients. The corresponding ADC values were calculated at b =800. The sensitivity,specificity,and accuracy of the single enhanced scan and the combined magnetic resonance dynamic enhanced scan were recorded and counted. Positive and negative predictive values,analysis of magnetic resonance dynamics and diffusion-weighted imaging in the diagnosis and value of primary liver cancer patients. Results All 57 cases of suspected hepatic tumors were confirmed by surgical pathological examination. Among them,46 cases were primary liver cancer,6 cases were hepatic cavernous hemangiomas,and 5 cases were hepatic cysts. ADC values in primary liver cancer patient was lower than those of hemangiomas,and hepatic cysts patients( P < 0. 05). Hepatic hemangioma ADC values were lower than hepatic cysts( P < 0. 05). DCE-MRI combined with DWI diagnosis eventually diagnosed in 57 cases,and the coincidence rate was 100. 00% compared with pathological diagnosis. DCE-MRI was finally diagnosed in 55 cases,and the coincidence rate was 96. 49%compared with pathological diagnosis. The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of DCE-MRI combined with DWI were higher than DCE-MRI( P < 0. 05). Conclusion The combination of dynamic contrast enhanced MR imaging and diffusion-weighted imaging in patients with primary liver cancer can improve the diagnostic compliance rate,obtain high diagnostic efficiency,and provide imaging basis for clinical diagnosis. It is worthy of popularization and application.更多还原