不同分化程度HCC的Gd-EOB-DTPA MRI增强研究

发布时间：2018-03-11 20:31

本文选题：GD-EOB-DTPA　切入点：MRI　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨肝脏磁共振特殊对比剂GD-EOB-DTPA MRI增强表现在不同分化程度HCC的应用价值。材料与方法:本研究收集2011年11月至2016年2月期间在我院术前行MRI特异对比剂增强及DWI检查并行手术后有病理诊断的病人56例(男53例,女3例),年龄30-69岁,共61个病灶。按照病理分别分为高分化HCC10个病灶、中分化HCC24个病灶、低分化HCC17个病灶三组及对照组DN 10个病灶。扫描程序为,先常规MRI平扫,静脉注射GD-EOB-DTPA对比剂,0.12-0.2ml/kg,进行三期动态增强扫描,扫描时间分别为注射对比剂后25、60及120 S,20min后行特异期扫描,期间行DWI扫描。图像处理,在3.0TVerio磁共振仪后处理处用toolcircle测量病灶肝脏特异对比剂MRI增强图像各期信号值及ADC值,并计算病灶CR、ER、RER值。在肝脏特异对比剂MRI增强图像及DWI图像分析各组病灶数目、形态、大小、强化方式、信号表现,并观察病灶特异期信号的均匀程度。采用SPSS 1 7.0软件进行统计学处理。不同分化程度HCC患者的动脉期、门脉期、平衡期、特异期的CR、ER、RER采用LSD-t检验多重比较,特异期病灶信号均匀程度对比用卡方检验,检验水准0.05。结果:术后病理确诊的肝细胞癌及穿刺活检不典型增生结节患者56例,共61个病灶。61例病灶在T1WI图像均呈稍低-低信号、T2WI图像上均呈稍高信号,三期动态增强扫描表现存在差异:39个病灶(其中DN1例,高分化4个、中分化19个、低分化15个)呈典型的"快进快出"表现,另22个呈不典型表现。肝胆特异期图像上除了3个高分化HCC病灶及2个DN病灶的信号呈高信号外其余均表现为低信号;特异期不同分化程度HCC低信号均匀程度不一致,但差异无统计学意义(p0.05)。DWI图像上DN均呈低信号,HCC病例均见明显弥散受限,呈明显高信号;不同分化程度HCC的ADC值比较差异无统计学意义(P0.05)。在动脉期、门脉期、平衡期及特异期各组强化率(ER)、相对强化率(RER)分别两两比较,差异无统计学意义(P0.05)。在肝胆特异期图像上,DN组与高、中、低分化HCC三组的对比率(CR),高分化HCC与低分化HCC的CR之间比较均存在差异,且具有统计学意义(p0.05);但在动脉期、门脉期、平衡期,DN组及高、中、低分化HCC三组之间CR之间比较差异无统计学意义(p0.05)。结论:大部分中、低分化HCC强化方式典型,少部分中低分化HCC及大部分高分化HCC强化方式不典型;特异期病灶底信号的均匀程度对评估HCC的分化程度意义不大;肝脏特异对比剂MRI增强检查肝胆特异期病灶信号对比率与病灶良恶性程度相关,特异期病灶信号对比率的测量对良恶性鉴别及评估不同分化程度HCC有重要意义。
[Abstract]:Objective: to investigate the value of contrast-enhanced GD-EOB-DTPA MRI in different differentiation degree of HCC. Materials and methods: from November 2011 to February 2016, we performed MRI specific contrast enhancement in our hospital from November 2011 to February 2016. There were 56 patients (53 males, 53 males) with pathological diagnosis after operation by strong and DWI examination. Three female patients, aged 30-69 years, were divided into three groups according to pathology: well-differentiated HCC10, moderately differentiated HCC24, low-differentiated HCC17, and control group. GD-EOB-DTPA contrast agent 0.12-0.2ml / kg was injected intravenously to perform three phase dynamic contrast-enhanced scanning. The scanning time was 2560 min after injection of contrast agent and 120Sh 20min after injection, and then DWI scan was performed. Toolcircle was used to measure the signal value and ADC value of liver specific contrast agent MRI enhancement images at the post-processing point of 3.0T Verio MRI. The number, shape and size of the lesions were analyzed by MRI enhanced images and DWI images. Enhancement mode, signal manifestation, and the homogeneity of the signal in the specific phase of the lesion were observed. Statistical analysis was carried out with the software of SPSS 17.0.The arterial phase, portal phase, equilibrium phase of HCC patients with different differentiation degrees were analyzed. The LSD-t test was used to compare the signal uniformity of specific stage lesions with chi-square test. Results: 56 patients with hepatocellular carcinoma and atypical hyperplastic nodules were diagnosed by pathological examination after operation. A total of 61 lesions were slightly hypointensity on T _ 1WI and slightly hyperintense on T _ 2WI images. There were significant differences in dynamic contrast-enhanced imaging findings in three phases: 39 lesions (including DN1, 4 well differentiated, 19 moderately differentiated). Low differentiation (15) showed typical fast in and out (22 cases). In hepatobiliary phase images, the signal intensity of 3 well-differentiated HCC lesions and 2 DN lesions showed hypointensity, except for 3 well-differentiated HCC lesions and 2 DN lesions. There was no significant difference in the homogeneity of low signal intensity in different differentiation degree of HCC, but the difference was not statistically significant. All the cases with low signal intensity on HCC images were obviously diffusion-limited and showed obvious high signal intensity. There was no significant difference in the ADC value of HCC with different differentiation degrees (P 0.05). The enhancement rate and relative enhancement rate were compared in arterial phase, portal phase, equilibrium stage and specific stage, respectively. There was no significant difference in contrast ratio between DN group and high, middle and low differentiated HCC groups, and there was significant difference in CR between well-differentiated HCC and poorly differentiated HCC, but in arterial phase, portal phase, there was no significant difference between the three groups in the specific phase of hepatobiliary tract (P 0.05), but in arterial phase, portal phase, there was no significant difference in the contrast ratio between the three groups (P 0.05), but in arterial phase, portal phase, there were significant differences in the contrast ratio between the three groups. There was no significant difference in CR between the three groups (P 0.05). Conclusion: in most cases, the enhancement mode of low-differentiated HCC is typical, and a few of middle-low-differentiated HCC and most of well-differentiated HCC are not typical. The homogeneity of the signal at the bottom of the lesion in the specific phase is of little significance in evaluating the differentiation of HCC, and the ratio of the signal to the signal in the liver and bile specific phase is correlated with the degree of benign and malignant lesions. The measurement of signal pair ratio is of great significance in differentiating benign and malignant lesions and evaluating HCC with different degrees of differentiation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R575;R735.7

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