MR弥散加权成像对泡型肝包虫病的评估价值研究

发布时间：2018-10-05 15:35

【摘要】：目的分析泡型肝包虫病的磁共振(MR)弥散加权成像(DWI)的特征,评估表观弥散系数(ADC)在泡型肝包虫病中的潜在应用价值。方法回顾性分析2013年11月至2015年1月期间青海大学附属医院根据流行病学、实验室检验和影像学检查及外科手术确诊为泡型肝包虫病的26例患者的临床资料,行3.0 T MR肝脏平扫,DWI序列的b值分别为0、600、1 000、1 200 s/mm~2。所有数据储存至PACS系统,经两名副主任医师参与评定病灶的分型、大小、分布、位置、钙化(CT检查)特征,测量不同b值下包虫中心区、边缘区、周边区肝实质的ADC值并进行比较。结果 1 26例患者共有29个病灶,多累及多个肝段,21个(72%)病灶分布于右半肝,同时累及左、右叶者有4个。24个病灶侵犯肝静脉或门静脉,20个病灶侵犯肝内胆管,10个病灶侵犯右侧肾上腺。7例患者出现肝门区、腹膜后多发增大淋巴结,5例患者出现肺转移,3例患者出现脑转移,同时有肺转移及脑转移患者3例。2液化坏死性病灶20个,其中5个病灶的T2WI边缘有多发小囊,15个病灶的T2WI边缘均为实性成分并未见小囊;12个病灶的中心区DWI呈明显高信号,8个病灶的中心区DWI呈低信号。实性病灶9个,其中有2个病灶的边缘T2WI有小囊,有7个病灶的T2WI为实性成分;实性病灶的DWI为均匀一致的低信号,边缘有均匀少量较连续或不连续环形高信号。3在同一b值下,液化坏死性病灶中心区的ADC值均明显高于实性病灶(P0.01)。在液化坏死性病灶内不同b值下,周边区的ADC值均明显低于边缘区(P0.01)和中心区(P0.05);在实性病灶内不同b值下,周边区和边缘区的ADC值均明显低于中心区(P0.05)。结论 MR的DWI能清晰分辨泡型肝包虫的结构及成分,对区别肝脏其他疾病有较高的价值。液化坏死性病灶中心区的平均ADC值明显高于实性病灶中心区的ADC值。
[Abstract]:Objective to analyze the characteristics of Mr (MR) diffusion weighted imaging (DWI) in alveolar hepatic hydatid disease and to evaluate the potential value of apparent diffusion coefficient (ADC) in the diagnosis of alveolar hepatic hydatid disease. Methods from November 2013 to January 2015, the clinical data of 26 patients with alveolar hepatic hydatid disease diagnosed by epidemiology, laboratory examination, imaging examination and surgical operation were retrospectively analyzed in the affiliated Hospital of Qinghai University. The b value of 3. 0 T MR plain scan DWI sequence was 0 ~ 600 ~ 1 000 ~ 1 200 s / m ~ 2 / mm ~ (-2) respectively. All the data were stored in the PACS system. The types, size, distribution, location, calcification (CT) characteristics of the lesions were assessed by two deputy chief physicians, and the central and marginal areas of hydatid were measured under different b values. The ADC values of peripheral liver parenchyma were compared. Results there were 29 lesions in 126 patients with multiple liver segments, 21 lesions (72%) were located in the right half liver, and left liver was also involved. In 4 patients with right lobe, 24 lesions invaded hepatic vein or portal vein, 20 lesions invaded intrahepatic bile duct, 10 lesions invaded right adrenal gland. Pulmonary metastasis occurred in 5 patients with retroperitoneal multiple enlarged lymph nodes and brain metastasis in 3 patients, and 20 liquefaction necrotic lesions in 3 patients with pulmonary metastasis and brain metastasis. In 5 lesions, there were multiple vesicles in the T2WI margin, and in 15 lesions, there were no solid components in the T2WI margin, and the DWI in the central region of 12 lesions was significantly hyperintense, and the DWI in the central region of 8 lesions was low signal intensity. There were 9 solid lesions, 2 of which had microcapsules at the edge of T2WI, 7 of which had T2WI as solid components, and the DWI of solid lesions was homogeneously low signal. At the same b value, the ADC values in the central region of the liquefaction necrotic lesions were significantly higher than those in the solid lesions (P0.01). The ADC values of peripheral areas were significantly lower than those of marginal areas (P0.01) and central areas (P0.05), and the ADC values of peripheral and marginal areas were significantly lower than those of central areas (P0.05). Conclusion DWI of MR can distinguish the structure and composition of hepatic hydatid clearly, and it is valuable to distinguish other liver diseases. The mean ADC value of the liquefaction necrotic lesion was significantly higher than that of the solid lesion.
【作者单位】：青海大学附属医院影像中心;
【基金】：2013青海省科技厅应用基础项目(编号:2013-Z-732)~~
【分类号】：R445.2;R532.32

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