肝细胞癌患者门静脉良、恶性血栓的鉴别诊断：弥散加权 MR 成像的应用。

Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging.

机构信息

Department of Abdominal and Interventional Radiology, Massachusetts General Hospital, 55 Fruit St, WHT 270, Boston, MA 02114, USA.

出版信息

Radiology. 2010 Jan;254(1):154-62. doi: 10.1148/radiol.09090304.

DOI:10.1148/radiol.09090304

PMID:20032150

Abstract

PURPOSE

To investigate the utility of diffusion-weighted (DW) imaging in distinguishing bland thrombus from neoplastic thrombus in the portal vein in patients with hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

In this retrospective institutional review board-approved HIPAA-complaint study, the imaging results in 25 patients (16 men [average age, 62.3 years; range, 35-75 years] and nine women [average age, 58.4 years; range, 32-69 years]; overall average age, 60.1 years; range, 32-75 years) with HCC and portal vein thrombosis who were examined with both contrast material-enhanced computed tomography (CT) and 1.5-T magnetic resonance (MR) imaging were reviewed. Axial echo-planar two-dimensional DW imaging was performed by using b values of 50, 400, and 800 sec/mm(2). A thrombus was considered neoplastic if it expanded the vessel or enhanced on the dynamic CT and MR images; otherwise it was considered bland. The signal intensity (SI) of the thrombus and HCC lesions in the same patients was compared on DW images. The results were evaluated by using the Fisher exact test. The apparent diffusion coefficients (ADCs) of HCC and thrombus were used to compute the ratio of the ADC of the thrombus to the ADC of the tumor.

RESULTS

On DW images, 15 of 19 neoplastic thrombi demonstrated same SI and four showed lower SI than the primary HCC. Each of the six bland thrombi had lower SI than the primary HCC (P < .001). The mean ADC of HCC and thrombus in the neoplastic thrombus group was 0.87 x 10(-3) mm(2)/sec and 0.88 x 10(-3) mm(2)/sec, respectively (P = .45). The ADC of the bland thrombus was 2.89 x 10(-3) mm(2)/sec, significantly higher than the ADC of the HCC (1.0 x 10(-3) mm(2)/sec, P < .0003). The ratio of the ADC of the thrombus to the ADC of the tumor in the bland thrombus group was 2.9 compared with 0.998 in the neoplastic group (P = .0003).

CONCLUSION

DW imaging enables discrimination between bland and neoplastic portal vein thrombi when the ratio of the ADC of the thrombus to the ADC of HCC was lower than 2 and when the thrombi showed similar SI as the primary HCC when qualitative analysis was performed.

摘要

目的

探讨扩散加权（DW）成像在鉴别肝细胞癌（HCC）患者门静脉内良性与肿瘤性血栓中的作用。

材料与方法

本回顾性研究经机构审查委员会批准并符合 HIPAA 规定，纳入 25 例 HCC 合并门静脉血栓形成患者（男 16 例，平均年龄 62.3 岁[范围，35-75 岁]；女 9 例，平均年龄 58.4 岁[范围，32-69 岁]；总体平均年龄 60.1 岁[范围，32-75 岁]）。所有患者均行对比增强 CT 和 1.5-T MR 成像检查。采用 b 值为 50、400 和 800 sec/mm2 的轴位平面回波弥散加权成像。如果血栓使血管扩张或在动态 CT 和 MR 图像上增强，则认为是肿瘤性血栓，否则为良性血栓。比较同一患者的血栓和 HCC 病变在 DW 图像上的信号强度（SI）。采用 Fisher 确切概率法评估结果。计算 HCC 和血栓的表观弥散系数（ADC）比值，以评估血栓的 ADC 与肿瘤 ADC 的比值。

结果

DW 图像上，19 例肿瘤性血栓中有 15 例的 SI 与原发性 HCC 相同，4 例的 SI 低于原发性 HCC。6 例良性血栓的 SI 均低于原发性 HCC（P<0.001）。肿瘤性血栓组 HCC 和血栓的平均 ADC 分别为 0.87×10-3mm2/sec 和 0.88×10-3mm2/sec（P=0.45）。良性血栓的 ADC 为 2.89×10-3mm2/sec，明显高于 HCC 的 ADC（1.0×10-3mm2/sec，P<0.0003）。良性血栓组血栓的 ADC 与 HCC 的 ADC 比值为 2.9，而肿瘤性血栓组为 0.998（P=0.0003）。