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目的:探讨肝血管瘤和肝细胞癌在MR DWI和LAVA动态增强上的表现特征。方法:回顾性分析有完整临床资料,经手术病理或临床证实的肝血管瘤18例,肝细胞癌17例,共35例病例的MRI图像,随机选取37个病灶,其中肝血管瘤20个病灶、肝细胞癌17个病灶,同时选取20例无肝脏病变者的正常肝组织。扫描序列为常规自旋回波序列(T2WI、正反相位)、LAVA动态增强序列及DWI检查(b值分别为0和500s/mm2),对病灶DWI的信号及LAVA增强扫描特点进行分析,并对病灶及正常肝组织的ADC值进行测量,比较是否有差异。结果:多数(15/20)肝血管瘤病灶在DWI上表现为稍高信号,多数(14/17)肝细胞癌病灶表现为高信号,两者信号特点分布差异有统计学意义(P<0.05);正常肝组织的平均表观扩散现象(ADC)值为(1.16±0.12)×10-3mm2/s,肝血管瘤平均ADC值为(2.03±0.15)×10-3mm2/s,明显高于肝细胞癌的平均值(1.42±0.16)×10-3mm2/s(P<0.05)。20个肝血管瘤病灶LAVA动态增强表现出两种方式,15个(15/20,75.0%)病灶呈动脉期病灶边缘结节状明显强化,门静脉期及延时期强化向心性充填;5个(5/20,25.0%)病灶呈动脉期均匀强化,门静脉期和延迟期稍高于或等于肝实质。而17个肝细胞癌病灶LAVA动态增强表现出两种方式,14个(14/17,82.4%)病灶动脉期明显强化,门静脉期及延时期强化消退,强化表现为“快进快出”;3个(3/17,17.6%)病灶于动脉期未见明显强化,门静脉期及延迟期轻度强化。11个(11/17,64.7%)肝细胞癌病灶显示完整的假包膜,且于门静脉期及延迟期强化。结论:DWI结合LAVA技术对肝血管瘤和肝细胞癌的鉴别诊断具有重要的临床应用价值。
Objective: To investigate the characteristics of liver hemangiomas and hepatocellular carcinoma in the dynamic enhancement of MR DWI and LAVA. Methods: A retrospective analysis of complete clinical data, 18 cases of hepatoma and 17 cases of hepatocellular carcinoma confirmed by pathology or clinical confirmed MRI images of 35 cases were randomly selected, of which 37 lesions were hepatic hemangiomas , 17 hepatocellular carcinoma lesions and 20 normal liver tissues without liver lesions. Scanning sequences were analyzed by conventional spin echo (T2WI, forward and reverse phase), LAVA dynamic enhancement sequence and DWI (b values were 0 and 500s / mm2, respectively), and the features of DWI signal and LAVA enhanced scan were analyzed. ADC values of lesions and normal liver tissue were measured and compared for differences. Results: Most (15/20) hepatic hemangiomas showed slightly higher signal intensity on DWI, and most (14/17) hepatocellular carcinoma lesions showed high signal intensity, the difference of signal characteristics between the two groups was statistically significant (P <0.05 ). The average ADC value of normal liver tissue was (1.16 ± 0.12) × 10-3mm2 / s and that of hepatic hemangioma was (2.03 ± 0.15) × 10-3mm2 / s, which was significantly higher than The average value of hepatocellular carcinoma (1.42 ± 0.16) × 10-3mm2 / s (P <0.05). Twenty haemangioma lesions showed dynamic enhancement of LAVA in two ways. Fifteen lesions (15/20, 75.0%) showed obvious enhancement of borderline nodules in the arterial phase and enhanced centripetal filling in the portal vein and the delayed phase. Five (5 / 20,25.0%) lesions were uniformly enhanced arterial phase, portal phase and delayed slightly higher than or equal to the liver parenchyma. However, the dynamic enhancement of LAVA in 17 hepatocellular carcinoma showed two ways, 14 (14 / 17,82.4%) lesions were significantly enhanced arterial phase, portal vein and delayed enhancement intensified regression, enhanced performance Three lesions (3/17, 17.6%) showed no significant enhancement in the arterial phase and slight portal vein and delayed enhancement. Eleven (11/17, 64.7%) hepatocellular carcinoma lesions showed a complete pseudocapsule and were potentiated in the portal and late phases. Conclusion: DWI combined with LAVA technique has important clinical value in the differential diagnosis of hepatic hemangiomas and hepatocellular carcinoma.