CT及MR检查在肝细胞癌诊断中的应用价值比较

摘要/Abstract

摘要： 目的研究与对比计算机断层扫描（CT）与磁共振（MR）检查在肝细胞癌诊断中的应用价值。方法选取2020年1月—2022年8月在临沂市中心医院就诊的120例疑似肝细胞癌患者,在患者中开展CT平扫+增强扫描、MR平扫、磁共振弥散加权成像（DWI）检查,对比CT、MR平扫、DWI对于肝细胞癌的诊断价值。结果依照诊断金标准（穿刺活检病理诊断或手术病理诊断结果）,在肝细胞癌诊断时,MR平扫、DWI的灵敏度、特异度、准确率、阳性预测值及阴性预测值高于CT,且DWI高于MR平扫（P<0.05）。DWI、MR平扫的诊断结果与病理诊断结果之间呈高度一致（Kappa=0.892、0.745）,而CT的诊断结果与病理诊断结果之间的一致性为中度（Kappa=0.561）。在早期肝细胞癌诊断中,DWI、MR平扫的诊断符合率均比CT更高,DWI的诊断符合率比MR平扫更高（P<0.05）。结论 MR对于肝细胞癌的诊断价值优于CT,尤其是DWI检查,可更加灵敏、准确地诊断肝细胞癌,还可辅助鉴别诊断肝细胞癌的分期。

关键词: 肝细胞癌, 诊断, 磁共振, 计算机断层扫描, 弥散加权成像

Abstract: Objective To study and compare the application value of computed tomography (CT) and magnetic resonance (MR) in the diagnosis of hepatocellular carcinoma. Methods 120 patients with suspected hepatocellular carcinoma who visited Linyi Central Hospital from January 2020 to August 2022 were selected. CT plain scan and enhanced scan, MR plain scan, and diffusion weighted imaging (DWI) were performed in the patients to compare the results of CT, MR plain scan and DWI in the diagnosis of hepatocellular carcinoma. Results According to the gold standard of diagnosis (results of pathological diagnosis of puncture biopsy or surgical pathology), in the diagnosis of hepatocellular carcinoma, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MR plain scan and DWI were higher than those of CT, while the diagnostic indexes of DWI were higher than those of MR plain scan （P<0.05）. The diagnostic results of DWI and MR plain scan were highly consistent with the pathological diagnosis (Kappa=0.892, 0.745), while the diagnostic result of CT was moderately consistent with the pathological diagnosis (Kappa=0.561). In the diagnosis of early hepatocellular carcinoma, the diagnostic coincidence rate of DWI and MR plain scan was higher than that of CT, and the diagnostic coincidence rate of DWI was higher than that of MR plain scan (P<0.05). Conclusion For hepatocellular carcinoma, the diagnostic value of MR is superior to that of CT, especially DWI, which can detect hepatocellular carcinoma more sensitively and accurately, and also assist in differential diagnosis of the staging of hepatocellular carcinoma.

Key words: hepatocellular carcinoma, diagnosis, magnetic resonance, computed tomography, diffusion weighted imaging

中图分类号:

R735.7

邹广东, 黄兆栋. CT及MR检查在肝细胞癌诊断中的应用价值比较[J]. 中华养生保健, 2023, 41(9): 22-26.

ZOU Guang-dong, HUANG Zhao-dong. The Value of Contrast CT and MR in the Diagnosis of Hepatocellular Carcinoma[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(9): 22-26.

参考文献

[1] 包惠桢,宋普姣,谢晓菲.11C-乙酸盐PET/CT显像对肝细胞癌的辅助诊断价值[J].中国医学影像学杂志,2022,30(8):803-808.
[2] 石莹莹,王元喜.应用肝脏影像报告与数据管理系统诊断肝细胞癌的价值研究[J].实用肝脏病杂志,2020,23(1):98-101.
[3] 葛攀,王志刚,赵德官,等.肝脏动态增强CT与肝脏MRI诊断肝细胞癌对比分析[J].实用临沂市中心医院临床杂志,2018,15(2):105-107.
[4] 井昶萍,韩冬,陆洋.CT灌注参数与肝细胞癌患者Child-Pugh分级的关系研究[J].肝脏,2021,26(10):1119-1122.
[5] 张骏,廖凯兵,刘红翠,等.DWI、T2WI及MRI动态增强扫描成像对不同分化小肝细胞癌的定量诊断研究[J].中国医学装备,2019,16(7):95-98.
[6] 刘岩.多b值DWI联合MRI动态增强扫描对诊断肝细胞癌的价值探讨[J].中国现代医生,2018,56(24):119-122,封3.
[7] 黎雅琳,黄婷婷,周彦汝,等.钆塞酸二钠动态增强MRI在微小肝细胞癌中的诊断价值[J].实用放射学杂志,2022,38(8):1273-1277.
[8] 李光,张金凤,苏果.CT与MR功能成像在肝脏恶性肿瘤鉴别诊断中的价值分析[J].河南医学研究,2020,29(12):2248-2250.
[9] 陈月,沈俊杰.增强CT与增强磁共振成像诊断肝细胞癌病灶的对比研究[J].影像科学与光化学,2021,39(6):831-835.
[10] 鲁雪红,张源,刘文亚.多排螺旋CT三期增强与3.0T MR多期动态增强扫描诊断肝细胞癌的价值分析[J].实用肝脏病杂志,2018,21(5):749-752.
[11] 周琳,周欣,张华文,等.肝脏动态增强CT与MRI检查对肝细胞癌的诊断效能比较[J].癌症进展,2021,19(19):1992-1994,2019.
[12] 樊伟. 原发性肝细胞癌CT及MRI影像学表现特征及诊断价值分析[J].实用中西医结合临床,2021,21(6):117-118,122.
[13] 高延忠,王明利.CT联合MRI评估肝细胞癌病理分级可行性研究[J].陕西医学杂志,2022,51(3):375-377,381.
[14] 唐艳军,尚伟,刘枫,等.DWI、T2WI及MRI动态增强扫描成像对不同分化小肝细胞癌的定量诊断研究[J].实用癌症杂志,2020,35(10):1711-1713,1738.
[15] 曾飞祥,毛思鑫,吴伟军.Gd-EOB-DTPA对比增强与DWI两种成像方法诊断小肝细胞癌的临床价值[J].医学临床研究,2021,38(12):1795-1797,1801.
[16] 刘岩. 不同b值DWI对肝细胞癌的诊断价值[J].中国实验诊断学,2018,22(11):1949-1951.