多b值扩散加权成像在原发性和转移性肝癌鉴别诊断中的价值

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摘要目的：探讨多b值DWI双指数函数模式在原发性和转移性肝癌鉴别诊断中的价值。方法：对41例经手术病理或穿刺证实的原发性肝癌（23例）和转移性肝癌（18例）行多b值DWI扫描，b值取0、100、400、800、1 200 s/mm2，测量单指数函数Slow ADC-Mono、Fast ADC-Mono和双指数函数Slow ADC-bi、Fast ADC-bi的定量值，相关数据行统计学分析。结果：单因素方差分析结果示，除Fast ADC-Mono外，Slow ADC-Mono、Slow ADC-bi、Fast ADC-bi定量值在原发性肝癌、转移性肝癌及正常组织间比较差异均有统计学意义（P＜0.05）。LSD两两比较显示，Slow ADC-Mono、Fast ADC-Mono定量值在原发性肝癌与转移性肝癌间比较差异无统计学意义（P＞0.05），Slow ADC-bi和Fast ADC-bi定量值在原发性肝癌、转移性肝癌间比较差异有统计学意义（P＜0.05）。Slow ADC-bi定量值转移性肝癌最低，原发性肝癌次之，正常组织最高，而Fast ADC-bi定量值正常组织最低，转移性肝癌次之，原发性肝癌最高。同一病种或正常组织，无论是单指数函数模式还是双指数函数模式，Fast ADC定量值远远大于Slow ADC定量值。结论：双指数函数模式的Slow ADC和Fast ADC参数在一定程度上反映了恶性肿瘤的细胞学特征。多b值DWI的双指数函数模式对原发性肝癌和转移性肝癌鉴别诊断具有一定意义。

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	章智敬
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关键词 ：肝肿瘤, 磁共振成像, 扩散加权成像, 指数模型

Abstract：Objective: To investigate the value of multi b-value DWI double exponential function model in differential diagnosis between primary and metastatic hepatocellular carcinoma. Methods: Forty-one cases of primary hepatocellular carcinoma (23 cases) and metastatic hepatocellular carcinoma (18 cases) confirmed by surgical pathology or puncture were scanned by multi b-value DWI of MRI, being 0, 100, 400, 800, 400 s/mm2. The quantitative values of single exponential function (Slow ADC-Mono, Fast ADC-Mono) and double exponential function (Slow ADC-bi, Fast ADC-bi) were measured and related data were analyzed. Results: Except Fast ADC-Mono, the quantitative values of Slow ADC-Mono, Slow ADC-bi, and Fast ADC-bi were statistically different among primary hepatocellular carcinoma, metastatic hepatocellular carcinoma and normal tissue by single factor analysis of variance. Comparing the LSD results of primary hepatocellular carcinoma and metastatic hepatocellular carcinoma, the quantitative values of both Slow ADC-Mono and Fast ADC-Mono showed no statistical difference between the two groups, while the values of Slow ADC-bi and Fast ADC-bi were statistically different. The quantitative values of Slow ADC-bi were highest in normal tissues, followed by primary liver cancer and lowest in metastatic liver cancer, while the Fast ADC-bi values were highest in primary liver cancer, followed by metastatic liver cancer and highest in normal tissues. In the same disease or normal tissues, whether they were in single exponential function model or double exponential function model, the quantitative values of Fast ADC were far greater than those of Slow ADC. Conclusion: The Slow ADC and Fast ADC parameters of the double exponential function model reflect the cytological characteristics of the malignant tumor to a certain extent. The double exponential function model of multi-b value DWI is of significance in differential diagnosis between primary hepatocellular carcinoma and metastatic hepatocellular carcinoma.

Key words： liver neoplasms magnetic resonance imaging diffusion weighted imaging exponential model

收稿日期: 2017-09-12

基金资助:温州市科技计划项目（Y20160473）。

通讯作者: 郑文龙，主任医师，Email：zwl6147@126.com。

作者简介: 章智敬（1976-），男，浙江永嘉人，副主任技师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I5/361

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