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目的探讨磁共振扩散加权成像(diffusion-weighted imaging,DWI)表观扩散系数(apparent diffusion coeffi-cient,ADC)值和指数化表观扩散系数(exponential apparent diffusion coefficient,eADC)值等与肝细胞癌(hepatocellu-lar carcinoma,HCC)的临床和病理特征之间的关系。方法选取行手术切除并经病理证实的HCC病例46例,手术前行DWI扫描,并计算低(100 s/mm2、200 s/mm2和300 s/mm2)、中(400 s/mm2和600 s/mm2)和高(800 s/mm2、1000 s/mm2和1200 s/mm2)b值时病灶边缘的ADC值和eADC值,然后根据低、高b值时ADC和eADC值的差异计算灌注ADC和eADC值。临床资料记录患者的甲胎蛋白(AFP)水平、病灶大小、病理分级、有无包膜、肝硬化、腹腔积液、门静脉癌栓及周围子灶等情况。将DWI测量参数与以上临床和病理特征进行对照分析。结果 ADC值随b值增加逐渐下降,而eADC值则逐渐增加。在腹腔积液组,中、高b值时的ADC值均大于无腹腔积液组,而高b值时的eADC值及灌注eADC值则相反(P<0.05)。在有、无肝硬化组,灌注ADC值分别为(1.36±0.38)×10-3mm2/s、(1.89±0.46)×10-3mm2/s;在AFP阳、阴性组,灌注eADC值分别为0.25±0.06、0.18±0.05;在有、无门静脉癌栓组,灌注ADC值分别为(1.17±0.16)×10-3mm2/s、(1.46±0.36)×10-3mm2/s,均分别具有统计学差异(P<0.05)。各ADC及eADC测量值在病理分级、病灶大小、有无肝癌周边子灶及包膜之间无差异(P>0.05)。结论灌注ADC和eADC值可在一定程度上对HCC的生物学行为进行无创性评估,有一定的临床价值。
Objective To investigate the value of apparent diffusion coeffi- cient (ADC) and exponential apparent diffusion coefficient (eADC) in diffusion-weighted imaging (DWI) (hepatocellu-lar carcinoma, HCC) between the clinical and pathological features. Methods Forty - six patients with HCC confirmed by pathology underwent surgical resection and DWI scan before operation, and the results of low (100 s / mm 2, 200 s / mm 2 and 300 s / mm 2), medium (400 s / mm 2 and 600 s / mm2) and high (800 s / mm2, 1000 s / mm2 and 1200 s / mm2) b values at the edge of the lesion, and then calculate the ADC and eADC values based on low and high b values And eADC value. Clinical data of patients with AFP (AFP) level, lesion size, pathological grade, with or without capsule, cirrhosis, ascites, portal vein tumor thrombus and surrounding foci and so on. The DWI measurement parameters were compared with the above clinical and pathological features. Results ADC value decreased with the increase of b value, while eADC value increased gradually. In the ascites group, ADC values were higher in the middle and high b values than in the ascites group, while eADC values and perfusion eADC values were higher in the high b values (P <0.05). The ADC values of perfusion were (1.36 ± 0.38) × 10-3mm2 / s and (1.89 ± 0.46) × 10-3mm2 / s in patients with and without cirrhosis, respectively. The values of eADC of perfusion in AFP positive and negative group were 0.25 ± 0.06 and 0.18 ± 0.05 respectively. The perfusion ADC values in the group with and without portal vein tumor embolus were (1.17 ± 0.16) × 10-3mm2 / s and (1.46 ± 0.36) × 10-3mm2 / s, respectively, Difference (P <0.05). The ADC and eADC measured values in the pathological grading, the size of the tumor, with or without liver cancer around the foci and capsule no difference (P> 0.05). Conclusion Perfusion of ADC and eADC can be a noninvasive assessment of the biological behavior of HCC to a certain extent, and have certain clinical value.