摘要
目的:探讨CT、MR几种功能成像(包括CT灌注、MR灌注和DWI成像)综合应用在肝脏疾病的诊断价值。方法:37例常规CT和/或MR诊断信心不足的患者,补充进行了DWI成像、CT和MR灌注成像以辅助诊断。其中,18例为肝癌术后或TACE、RFA、PEI等方法治疗后,对肝脏复发或原病灶治疗后活性情况的判断;7例为对肝内多发病灶的检出及诊断;4例肝脓肿;肝腺瘤3例,FNH5例。结果:37例患者在结合了功能成像后做出的综合影像诊断,较单纯常规CT和/或MR扫描,诊断准确率和病灶检出率均有提高。7例肝癌术后患者,常规平扫及增强扫描对术区是否有有活性的肿瘤残存还是局部复发诊断困难,DWI成像诊断为术后的炎性增生或肝脏局限性灌注异常。后患者经随访3-6个月,一般状况和生化指标无明显异常,且影像表现基本无变化。11例原发性肝癌TACE、RFA、PEI等方法治疗后的患者,CT和/或MR常规平扫及增强扫描可疑病灶仍有部分活性区但不能确定,加扫了DWI成像,其中的7例进行了MR灌注成像,6例进行了CT灌注成像。经ADC值以及灌注值的评估,病灶坏死区和残留活性区的区分更加明确。7例肝内多发病灶的患者,DWI图像较MR常规扫描检出病灶数目多且病灶显示更为清晰;4例肝脓肿、3例肝腺瘤,5例FNH患者常规CT/MR表现不典型,未能明确良恶性诊断,经DWI和灌注扫描均获明确定性,3例肝脓肿经超声导引下肝穿刺证实,2例肝腺瘤和3例FNH经受术证实,其余病例经临床及影像随访证实。结论:功能成像作为常规扫描的有益补充,其诊断价值不容忽视,可以提高病灶检出率和诊断准确率。
Objective： To investigate the diagnostic values of functional evaluation （including CT perfusion, MR perfusion and DWI） in liver disease. Methods： 37 patients underwent CT and MR functional evaluation when their conventional images could not give a confident diagnosis. Among them, 18 cases were hepatocellular carcinoma, 7 of the 18 cases were to have assessment on the recurrence after surgery, and 11 cases were to find if there were residual activity within the cancer after one of the 3 treatment （TACE, RFA, and PEo. Among the 37 patients, 7 cases were to have detect of multiple liver lesions, and the other 12 patients were to have diagnose of benign liver lesions （including 4 cases of liver abscess, 3 cases of hepatic adenoma and 5 cases of FNH）. Results： When combine the functional evaluation including CT perfusion, MR perfusion and DWI, diagnostic accuracy and lesion detection rate increased. 7 patients after sur-gical ectomy of the hepatocellular carcinoma were diagnosed as postoperative inftammatory hyperplasia or focal abnormal blood diffu- sion. As to the 11 cases of primary liver cancer after nonoperative treatment, suspicious lesions were found in the conventional CT and/or MR scanning. But in the functional images, the suspicious part of the lesion could be diagnosed as residual active area or necrotic area. For the 7 cases of multiple liver lesions, more lesions could be found in the DWI images than in the common MR images. The conventional CT/MR images failed to diagnose the 12 benign lesions, but the DWI and perfusion scan could distinguish them from malignant tumor. Conclusion： Functional evaluate including CT perfusion, MR perfusion and DWI, were useful complement to conventional scanning, and the diagnostic value should not be neglected. They can help to improve lesion detection rate and diagnostic accuracy in liver disease.
出处
《现代生物医学进展》
CAS
2012年第32期6298-6302,共5页
Progress in Modern Biomedicine
关键词
磁共振成像
计算机成像
扩散加权成像
灌注
肝脏
Magnetic resonance imaging
Computed tomography
Diffusion weighted imaging
Perfusion
Liver
