【作者】 张艳；

【导师】 刘影；

【作者基本信息】 安徽医科大学 ， 影像医学与核医学， 2021， 硕士

【摘要】 第一部分:HCC的动态增强模式:Gd-EOB-DTPA动态增强MRI与CT的比较目的:基于肿瘤细胞分化程度和实体肿瘤大小(≤2cm),评估Gd-EOB-DTPA增强MRI和CT检查对HCC的动态增强模式及其有无差异;同时分析Gd-EOB-DTPA增强MRI和增强CT检查对不典型增强模式HCC的诊断能力,旨在提高肝癌的术前诊断准确性,预估其恶性程度的可能。方法:回顾性分析2017年7月-2020年10月58例HCC患者共计67个病灶,术前均行Gd-EOB-DTPA动态增强MRI及动态增强CT扫描,根据手术的病理结果将HCC患者可分为高分化组(18个)、中或低分化组(49个);根据肿瘤大小可分为≤2cm和>2cm的两组;将HCC增强模式分为典型增强模式和不典型增强模式,进而基于肿瘤分化程度及大小来评价Gd-EOB-DTPA MRI和CT检查对HCC动态增强模式的差异,并评估对其不典型增强模式的诊断能力。结果:对于中或低分化HCC的典型增强模式,在GD-EOB-DTPA增强MRI检查上显示优于增强CT检查(P=0.009),但对于高分化HCC的典型增强模式,GD-EOB-DTPA增强MRI检查和增强CT检查之间无统计学意义(P=0.180);且对中或低分化HCC,两种检查对其典型增强模式的显示都优于高分化HCC(EOB-MRI:P=0.030;CT:P=0.041)。对于直径≤2cm的HCC,GD-EOB-DTPA增强MRI比增强CT检查更加敏感地描绘了HCC的典型增强模式(P=0.002),但在直径>2cm的HCC典型增强模式上两种检查之间无统计学意义(P=0.217),且仅在肿瘤直径>2cm上增强CT检查更加敏感地显示HCC的典型增强模式(P=0.018),而GD-EOB-DTPA增强MRI检查对于不同大小的HCC典型增强模式的显示无统计学意义(P=0.789)。对于不典型增强模式的HCC,可以通过肝胆期图像提高诊断HCC的效能,但无显著差异(P>0.05)。结论:对于中或低分化HCC的典型增强模式,在GD-EOB-DTPA增强MRI检查上的显示优于增强CT检查。对于直径≤2cm的肝细胞肝癌,GD-EOB-DTPA增强MRI比CT更能显示HCC的典型增强模式。对不典型增强模式的HCC,肝胆特异期可在一定程度上提高MRI诊断能力。第二部分:GD-EOB-DTPA MRI和CT动态增强对HCC血供的评估及其病理对照分析目的:基于GD-EOB-DTPA动态增强MRI和动态增强CT检查来探讨HCC的血供特点,并与病理结果进行对照分析,旨在分析两种检查方法在动态各期血供的差异性,并通过动脉期血供及肝胆期图像来预测HCC细胞分化程度的临床应用价值。方法:回顾性分析2017年7月-2020年10月58例经手术病理证实为HCC患者术前的GD-EOB-DTPA动态增强MRI及动态增强CT影像资料,共计67个病灶。根据手术的病理结果将HCC患者可分为高分化组(18个)、中分化组(35个)和低分化组(14个)。根据动态增强各期图像观察HCC在动脉期强化、门脉期减退及延迟期减退的情况;同时分别计算动态增强各期HCC-肝脏对比度(C_M)和肝胆期C_M及相对强化率(CER),并与病理结果进行对照分析。结果:研究发现EOB-MRI检查与CT动态增强中,二者在动脉期强化对HCC的检出,EOB-MRI检查与CT之间无统计学意义(P=0.069);在门静脉期减退对HCC的检出中,EOB-MRI检查优于CT(P=0.005);延迟期减退对HCC检出,EOB-MRI检查优于CT(P=0.003)。结果还发现CT检查动脉期C_M大于EOB-MRI(P=0.018),而EOB-MRI检查延迟期C_M值远小于CT(P<0.001)。另外,与动脉期C_M值及肝胆期C_M值相比,肝胆期CER与HCC分化程度之间相关性更好(r=0.367,P=0.001)。结论:对于HCC血供的显示,动脉期动态增强CT检查优于EOB-MRI,而延迟期EOB-MRI检查优于动态增强CT;肝胆期相对强化率越大进而预示HCC分化程度较好。更多还原

【Abstract】 Part1 Dynamic enhancement mode of HCC: comparison of Gd-EOB-DTPA dynamic enhancement MRI and CTObjective: Based on the degree of differentiation of tumor cells and the size of solid tumors(≤2cm),the dynamic enhancement mode of Gd-EOB-DTPA enhanced MRI and CT examination on HCC and whether there is any difference is evaluated.At the same time,it analyzes the diagnostic capabilities of Gd-EOB-DTPA enhanced MRI and enhanced CT for atypical enhancement patterns of HCC,aiming to improve the accuracy of preoperative diagnosis of liver cancer and predict the possibility of its malignancy.Methods : A total of 67 lesions in 58 HCC patients from July 2017 to October 2020 were retrospectively analyzed.Gd-EOB-DTPA dynamic enhanced MRI and dynamic enhanced CT scanning were performed before surgery.HCC patients can be divided into highly differentiated group(18 cases)and moderately or poorly differentiated group(49 cases)based on the pathological results of the operation.These patients were also divided into two groups(≤2cm and >2cm)according the tumor diameter.The enhancement mode of HCC is including typical and atypical groups,and then Based on the degree of tumor differentiation and size,the difference of the dynamic enhancement mode and the diagnostic ability of HCC between Gd-EOB-DTPA MRI and CT was evaluated.Results: For the typical enhancement pattern of moderately or poorly differentiated HCC,GD-EOB-DTPA enhanced MRI examination showed better than enhanced CT examination(P = 0.009),but for the typical enhancement pattern of highly differentiated HCC,there was no statistically significant difference between GD-EOB-DTPA enhanced MRI and enhanced CT(P =0.180);and for both moderately and poorly differentiated HCC,the typical enhancement pattern of both examinations was superior to that of highly differentiated HCC(EOB-MRI:P =0.030;CT: P = 0.041).All showed better than well-differentiated HCC.For HCC with diameter less than 2cm,GD-EOBDTPA enhanced MRI is more sensitive than enhanced CT to describe the typical enhancement pattern of HCC than enhanced CT(P = 0.002),but between the two examinations on the typical enhancement pattern of HCC with diameter >2cm,there is no statistical significance(P =0.217).The enhanced CT examination only shows the typical enhancement pattern more sensitively of HCC with diameter >bigger than 2cm(P =0.018),In the group of different sizes,the display of typical enhancement mode was not statistically significant(P =0.789)in MRI and CT.For HCC with atypical enhancement mode,hepatobiliary phase images can be used to improve the diagnostic efficiency of HCC,but there is no significant difference(P >0.05).Conclusion :The typical enhancement mode is displayed better on GD-EOB-DTPA enhanced MRI than on in the group of moderately or poorly differentiated HCC.For HCC with diameter less than 2cm,GD-EOB-DTPA enhanced MRI can show the typical enhancement pattern better than CT.For HCC with atypical enhancement mode,hepatobiliary specific phase can improve the diagnostic accuracy of MRI.Prat 2 GD-EOB-DTPA MRI and CT dynamic enhancement to evaluate the blood supply of HCC and pathological control analysisObjective:The characteristics of blood supply were discussed based on GD-EOB-DTPA dynamic enhancement MRI and dynamic enhancement CT,and compared with pathological results.The purpose of this study was to analyze the difference of blood supply between the two methods in dynamic stages.The clinical application value of HCC cell differentiation was predicted by arterial blood supply and hepatobiliary phase images.Methods:Retrospective analysis of the preoperative GD-EOB-DTPA dynamic enhancement MRI and dynamic enhancement CT image data of 58 patients confirmed by surgical pathology from July 2017 to October 2020,A total of 67 lesions.According to the pathological results of surgery,HCC patients can be divided into well-differentiated group(18),moderately-differentiated group(35)and poorly-differentiated group(14).According to the three-stage dynamic enhancement images HCC the arterial phase enhancement,portal phase decline and delayed phase decline were observed;at the same time,the dynamic three-phase HCC-liver contrast(C_M)and hepatobiliary phase C_M and contrast enhancement ratio(CER)were calculated,and compared with pathological results.Results:The study found that EOB-MRI examination and CT dynamic enhancement were not statistically significant in the detection of HCC in arterial phase enhancement(P=0.069),hypointensity on portal venous phase was seen more frequently with EOB-MRI than with CT(P=0.005),hypointensity on delayed phase was seen more frequently with EOB-MRI than with CT(P=0.003).The results also showed that the CT arterial phase C_M was greater than EOB-MRI(P=0.018),while the EOB-MRI delayed phase C_M was much less than CT(P<0.001).In addition,compared with the C_M value in the arterial phase and the C_M value in the hepatobiliary phase,the correlation between CER in the hepatobiliary phase and the degree of HCC differentiation was better(r=0.367,P=0.001).conclusion:For the display of HCC blood supply,dynamic enhanced CT in the arterial phase is better than EOB-MRI,and EOB-MRI in the delayed phase is better than dynamic enhanced CT;the greater the relative enhancement rate in the hepatobiliary phase,the better the degree of HCC differentiation.更多还原