标题：动态增强MRI与CT对乙型肝炎肝硬化背景下原发性肝癌的诊断价值

      作者：游家生 1，吕秀金 1，郭伟娟 2    1.汕尾逸挥基金医院医学影像科，广东 汕尾 516600；2.汕尾市海丰彭湃纪念医院CT/MR室，广东 汕尾 516600

      卷次： 2022年33卷1期

      【摘要】 目的 探讨动态增强核磁共振成像(MRI)与CT对乙型肝炎肝硬化背景下原发性肝癌的诊断价值。方法 选择2017年7月至2020年5月在汕尾逸挥基金医院接受治疗的46例乙型肝炎肝硬化合并原发性肝癌患者为研究对象，所有患者均接受动态增强MRI及CT检查，以病理组织诊断结果为诊断标准，比较动态增强MRI及CT对乙型肝炎肝硬化背景下原发性肝癌病灶包膜边缘的强化表现、影像学表现和对病灶的检出率。结果 46例患者中检出病灶61个，小肝癌及大肝癌分别为19例和27例，病灶分别为22个和39个；动态增强MRI扫描显示原发性肝癌病灶包膜完整环状强化率为57.38%，明显高于动态增强CT的37.70%，差异有统计学意义(P<0.05)；动态增强MRI扫描与CT扫描的原发性肝癌病灶包膜无明显强化率(26.23% vs 37.70%)和不完全环状强化率(16.39% vs 24.59%)比较，差异均无统计学意义(P>0.05)；动态增强MRI动脉期高信号率为95.08%，明显高于动态增强CT的80.33%，差异有统计学意义(P<0.05)；动态增强MRI对原发性小肝癌病灶的检出率为 95.45%，明显高于动态增强CT的 63.64%，差异有统计学意义(P<0.05)；动态增强MRI对原发性大肝癌病灶的检出率为97.44%，与动态增强CT对原发性大肝癌病灶的检出率92.31%比较差异无统计学意义(P>0.05)。结论 动态增强MRI及CT均可作为乙型肝炎肝硬化背景下原发性肝癌的诊断手段，但动态增强MRI更能清晰显示包膜强化和肝癌血供特点，在小肝癌诊断上更有优势。
      【关键词】 乙型肝炎肝硬化；原发性肝癌；动态增强核磁共振成像；动态增强CT；诊断价值
      【中图分类号】 R738.7 【文献标识码】 A 【文章编号】 1003—6350（2022）01—0079—04

Value of dynamic contrast-enhanced MRI and CT in the diagnosis of primary liver cancer in the context ofhepatitis B cirrhosis.
YOU Jia-sheng 1, LV Xiu-jin 1, GUO Wei-juan 2.1. Department of Medical Imaging, Shanwei YifanFund Hospital, Shanwei 516600, Guangdong, CHINA; 2. CT/MR Room, Haifeng Pengpai Memorial Hospital, Shanwei516600, Guangdong, CHINA
【Abstract】 Objective To explore the value of dynamic contrast-enhanced MRI and CT in the diagnosis of pri-mary liver cancer in the context of hepatitis B cirrhosis. Methods The 46 patients with hepatitis B cirrhosis and prima-ry liver cancer were selected as the study subjects, who received treatment at Shanwei Yifan Fund Hospital from July2017 to May 2020. All patients underwent dynamic contrast-enhanced MRI and CT examination. With the diagnosis ofpathological tissues as the diagnostic criteria, dynamic contrast-enhanced MRI and CT were compared on the enhance-ment of the lesion capsule edge, imaging features and the detection rate of the primary liver cancer in the context of hepa-titis B cirrhosis. Results In 46 patients, 61 lesions were detected, with 22 lesions in 19 cases of small liver cancer and39 lesions in 27 cases of large liver cancer. Dynamic contrast-enhanced MRI scans showed that the annular enhancementrate of intact capsule of primary liver cancer was 57.38%, which was significantly higher than 37.70% of dynamic con-trast-enhanced CT scan, and the difference was statistically significant (P<0.05). Compared with CT scan, dynamic con-trast-enhanced MRI scan had no obvious enhancement rate (26.23% vs 37.70%) and incomplete circular enhancementrate (16.39% vs 24.59%), and both differences were not statistically significant (P>0.05). The high signal rate of dynamiccontrast-enhanced MRI in arterial phase was 95.08% , which was significantly higher than 80.33% of dynamic con-trast-enhanced CT (P<0.05). The detection rate of dynamic contrast-enhanced MRI for primary small liver cancer was95.45%, which was significantly higher than 63.64% of dynamic contrast-enhanced CT for primary small liver cancer(P<0.05). The detection rate of dynamic contrast-enhanced MRI for primary large liver cancer was 97.44%, and therewas no statistically significant difference from 92.31% of dynamic contrast-enhanced CT for primary large liver cancer(P>0.05). Conclusion Both dynamic contrast-enhanced MRI and CT can be used as diagnostic methods for primaryliver cancer in the context of hepatitis B cirrhosis, but dynamic contrast-enhanced MRI can clearly show the characteris-tics of capsule enhancement and blood supply of liver cancer, which is more advantageous in the diagnosis of small livercancer.
      【Key words】 Hepatitis B cirrhosis; Primary liver cancer; Dynamic contrast-enhanced MRI; Dynamic contrast-en-hanced CT; Diagnostic value