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目的探讨MRI连续动态增强扫描对肝细胞癌的价值,提高肝细胞癌诊断符合率。方法 39例经组织学或临床证实的肝细胞癌患者同时行CT平扫,多期增强扫描和MRI平扫,连续动态增强扫描。观察连续动态增强肿瘤表现出的强化模式;在连续动态增强扫描MRI,绘制肿瘤、主动脉、门静脉及肝组织的时间-信号强度曲线,并重建各期动态图像。对2种增强所表现的良、恶性特征进行分类、计数和比较。结果在39例肝细胞癌的连续动态增强扫描时间-信号强度曲线类型,速升速降型27例、速升平缓降(或台)型6例、缓升下降型5例、缓慢上升型1例;多期增强的强化模式,动脉期强化、门静脉期及延迟期密度(信号)减低20例;动脉期强化、门静脉期及延迟期密度(信号)不减低5例,动脉期不强化、门静脉及延迟期强化4例;动脉期不强化、门静脉期及延迟期密度(信号)低于肝组织10例。MRI连续动态增强扫描表现出的恶性征象明显高于多期动态扫描的强化模式(χ~2=37.375,P<0.000)。在肿瘤的综合诊断中,诊断等级定为肯定良性、可能良性、不能确定、可能肝细胞癌和肯定肝细胞癌,连续动态增强扫描等级例数相应为1、2、3、5、28;多期动态扫描分别为2、3、6、7、21,连续动态增强扫描的诊断符合率明显高于多期增强扫描(χ~2=49.259,P<0.000)。结论 MRI连续动态增强扫描能获得组织完整的对比剂流入和廓清状态,与多期增强比较,有利于对肿瘤个性化分析,对肝细胞癌诊断符合率高,具有推广价值。
Objective To investigate the value of continuous dynamic contrast-enhanced MRI in the diagnosis of hepatocellular carcinoma (HCC) and to improve the coincidence rate of HCC diagnosis. Methods Thirty-nine patients with histologically confirmed or clinically confirmed hepatocellular carcinoma underwent CT scan, multi-phase enhanced MRI and plain MRI scan simultaneously and continuously with dynamic contrast-enhanced scan. The dynamic patterns of continuous dynamic enhancement of tumor were observed. In continuous dynamic contrast-enhanced MRI, the time-signal intensity curves of tumor, aorta, portal vein and liver tissue were drawn and the dynamic images were reconstructed. The two kinds of enhancement showed benign and malignant features were classified, counted and compared. Results In 39 cases of hepatocellular carcinoma with continuous dynamic contrast-enhanced scan time-signal intensity curve type, 27 cases were rapidly ascending and descending, 6 cases were ascending and descending slowly, 5 ascending descending, 5 ascending and descending In 20 cases, arterial phase intensification, portal venous phase and delayed phase density (signal) were not reduced in 5 cases, arterial phase was not enhanced, portal vein And delayed phase enhancement in 4 cases; arterial phase is not enhanced, portal vein phase and delayed phase density (signal) is lower than in 10 cases of liver tissue. The MRI manifestations of malignancy showed significantly higher malignancy than multi-phase dynamic scans (χ ~ 2 = 37.375, P <0.000). In the comprehensive diagnosis of the tumor, the diagnostic grade is set to be benign, may be benign, not sure, possible hepatocellular carcinoma and certainly hepatocellular carcinoma, continuous dynamic enhanced scan grade cases corresponding to 1,2,3,5,28; and more The dynamic scans were 2, 3, 6, 7, and 21, respectively. The diagnostic accuracy of continuous dynamic contrast-enhanced MRI was significantly higher than that of multi-phase enhanced scans (χ ~ 2 = 49.259, P <0.000). Conclusion Continuous dynamic contrast-enhanced MR imaging can obtain complete infiltration and clearance of contrast media. Compared with multi-phase enhancement, it is benefit to personalize the tumor and has a high coincidence rate in the diagnosis of hepatocellular carcinoma.