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目的探讨扩散加权成像(DWI)在肝细胞肝癌和周围型胆管细胞癌鉴别诊断中的价值。方法搜集经病理证实的肝细胞肝癌患者30例和周围型胆管细胞癌患者20例,均行b值为800 s/mm~2的DWI检查,比较两组表观扩散系数(ADC)值、瘤/肝值之间的差异,以及肿瘤与邻近肝实质之间的差异;采用受试者工作特征(ROC)曲线确定DWI对肝细胞肝癌和周围型胆管细胞癌的诊断效能及二者鉴别的最佳ADC值和瘤/肝值临界值。结果50例患者共54个肿瘤,所有肿瘤在DWI像上呈高信号,ADC图像呈低信号。肝细胞肝癌和周围型胆管细胞癌平均ADC值分别为(0.89±0.15)×10~(-3)mm~2/s和(1.05±0.14)×10~(-3)mm~2/s,二者差异有统计学意义(t=3.685,P<0.01),二者ADC值均低于邻近肝实质。肝细胞肝癌瘤/肝值低于周围型胆管细胞癌瘤/肝值,二者差异有统计学意义(t=2.760,P<0.01);ROC曲线确定ADC值和瘤/肝值诊断肝细胞肝癌和周围型胆管细胞癌的临界值分别为0.94×10~(-3)mm~2/s和0.83,敏感性和特异性分别为85%、70%和85%、60%,曲线下面积为0.783和0.732。结论DWI对肝细胞肝癌和周围型胆管细胞癌的鉴别诊断具有一定的价值。
Objective To investigate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of hepatocellular carcinoma and peripheral cholangiocarcinoma. Methods Thirty patients with hepatocellular carcinoma confirmed by pathology and 20 patients with peripheral cholangiocarcinoma were collected and examined by DWI with b value of 800 s / mm ~ 2. The apparent diffusion coefficient (ADC) / Liver value, and the difference between the tumor and the adjacent liver parenchyma; using the receiver operating characteristic (ROC) curve to determine the diagnostic efficacy of DWI on hepatocellular carcinoma and peripheral cholangiocarcinoma Good ADC value and tumor / liver value of the critical value. Results A total of 54 tumors were found in 50 patients. All tumors showed high signal on DWI images and low signal on ADC images. The average ADC values of hepatocellular carcinoma and peripheral cholangiocarcinoma were (0.89 ± 0.15) × 10 ~ (-3) mm ~ 2 / s and (1.05 ± 0.14) × 10 ~ (-3) mm ~ The difference was statistically significant (t = 3.685, P <0.01), ADC values of the two were lower than the adjacent liver parenchyma. Hepatocellular carcinoma / liver value was lower than that of peripheral cholangiocarcinoma / liver value, the difference was statistically significant (t = 2.760, P <0.01); ROC curve was used to determine the ADC value and tumor / And peripheral cholangiocarcinoma were 0.94 × 10 -3 mm 2 / s and 0.83, respectively. The sensitivity and specificity were 85%, 70%, 85% and 60% respectively. The area under the curve was 0.783 and 0.732. Conclusion DWI has certain value in the differential diagnosis of hepatocellular carcinoma and peripheral cholangiocarcinoma.