摘要
目的 探讨5.0T MRI磁敏感加权成像(SWI)对肝细胞癌(HCC)和肿块型肝内胆管癌(MICC)的鉴别诊断价值。资料与方法 回顾性纳入2023年3月-2024年11月安徽省立医院经病理证实的56例HCC和36例MICC,由2位医师独立分析SWI序列中两组病灶周围低信号环、病灶内出血及病灶与血管关系,进行组间一致性分析;比较两组上述特征的差异,并与MRI常规平扫/增强扫描对比;对于病灶内出血,通过计算其内部磁敏感信号量化出血对两者的诊断价值。结果 2位医师对HCC组和MICC组SWI上病灶低信号环、出血及病灶与血管关系一致性较好(Kappa=0.802~0.929,P<0.001)。与MRI平扫相比,SWI显著提高了肿瘤周围低信号环及肿瘤内出血的检出率(χ^(2)=89.409、46.210,P<0.001),这两种征象在HCC组更常见;磁敏感信号分级HCC以3级为主,MICC以1级为主,差异均有统计学意义(Z=-4.059,P<0.05);与增强扫描相比,SWI诊断两组病灶与血管之间的关系准确度高,差异无统计学意义(χ^(2)=0.275、0.247,P=0.871、0.619);HCC组肿瘤与血管关系主要表现为受压及癌栓形成,MICC组肿瘤与血管关系表现为侵犯改变(包括包裹、狭窄或闭塞),差异有统计学意义(Z=-6.809,P<0.001)。结论 5.0T MRI SWI序列可以清晰地显示HCC和MICC内部及周边结构,并能在不使用对比剂的情况下准确显示病灶与血管的关系,对于两者鉴别具有较好的临床应用价值。
Purpose To evaluate the differential diagnostic value of 5.0T MRI susceptibility-weighted imaging(SWI)in hepatocellular carcinoma(HCC)and mass-forming intrahepatic cholangiocarcinoma(MICC).Materials and Methods A total of 56 patients with HCC and 36 patients with MICC confirmed by pathology from March 2023 to November 2024 in Anhui Provincial Hospital were retrospectively enrolled.Two radiologists independently analyzed three features of the lesions,including the low-signal rims around the lesion,hemorrhage within the lesion,and the relationship between lesions and adjacent vessels,on the SWI sequence between the two groups,respectively,via inter-rater consistency analysis.These above features between the two groups were compared and contrasted them with those obtained from conventional MR plain and enhanced scans,respectively.For intralesional hemorrhages,the diagnostic value was quantified by calculating the internal tissue susceptibility signal.Results The radiologists showed good consistency in the low-signal rims,intratumoral hemorrhage as well as the relationship between the lesion and the blood vessel on the SWI in the HCC group and the MICC group(Kappa=0.802-0.929,all P<0.001).Compared with conventional MR plain,SWI significantly enhanced the detection rates of perilesional low-signal rims and intratumoral hemorrhage(χ^(2)=89.409,46.210,both P<0.001).These findings were more prevalent in HCC patients.The internal tissue susceptibility signal grading showed that HCC predominantly exhibited grade 3,whereas MICC predominantly exhibited grade 1,with statistically significant differences(Z=-4.059,P<0.05).Additionally,compared with enhanced MRI,SWI demonstrated higher accuracy in diagnosing the relationship between lesions and blood vessels in both groups;however,these differences were not statistically significant(χ^(2)=0.275,0.247,P=0.871,0.619).In the HCC group,the relationship between tumors and blood vessels was primarily characterized by compression and tumor thrombus formation,while in the MICC group,it was predominantly marked by invasive changes,including vessel encasement,stenosis or occlusion,with a statistically significant difference between the two groups(Z=-6.809,P<0.001).Conclusion SWI sequence of 5.0T MRI provides clear visualization of the internal and peripheral structures of HCC and MICC.It can accurately delineate the relationship between lesions and blood vessels without the need for contrast agents,offering significant clinical utility in differentiating these two conditions.
作者
陈旭丹
李少朋
音大为
黄亮亮
董立军
宋潇鹏
刘影
CHEN Xudan;LI Shaopeng;YIN Dawei;HUANG Liangliang;DONG Lijun;SONG Xiaopeng;LIU Ying(Department of Radiology,the First Affiliated Hospital of USTC(Anhui Provincial Hospital),Hefei 230001,China;不详)
出处
《中国医学影像学杂志》
北大核心
2025年第7期712-716,729,共6页
Chinese Journal of Medical Imaging
关键词
癌
肝细胞
胆管上皮癌
磁共振成像
磁敏感加权成像
超高场强
病理学
外科
诊断
鉴别
Carcinoma,hepatocellular
Cholangiocarcinoma
Magnetic resonance imaging
Susceptibility-weighted imaging
Ultra-high field
Pathology,surgical
Diagnosis,differential Chinese Journal of Medical Imaging,2025,33(7):712-716,729
