广西医学

目的探讨钆塞酸二钠（Gd⁃EOB⁃DTPA）增强MRI对肝局灶性结节增生（FNH）及肝细胞癌（HCC）的鉴别诊断价值。方法回顾性分析35例肝FNH患者（肝FNH组）及54例HCC患者（HCC组）的临床资料，比较两组Gd⁃EOB⁃DTPA增强MRI的影像学资料，采用多因素Logistic回归模型筛选与肝FNH相关的因素。采用受试者工作特征（ROC）曲线分析Gd⁃EOB⁃DTPA增强MRI的影像特征单独鉴别诊断肝FNH和HCC的价值。结果肝FNH组中心瘢痕、扩散加权成像低信号、动态强化方式（快进慢出）、肝胆期中心低或高信号伴外周高信号的比例及表观弥散系数（ADC）值高于HCC组（P<0.05）。多因素Logistic回归分析结果显示，动态强化方式（快进慢出）、肝胆期中心低或高信号伴外周高信号、ADC值升高与肝FNH有关（P<0.05）。ROC曲线分析结果显示，动态强化方式（快进慢出）、肝胆期中心低或高信号伴外周高信号、ADC值鉴别诊断肝FNH和HCC的曲线下面积分别为0.788、0.864、0.810，三者鉴别诊断效能相当。结论 Gd⁃EOB⁃DTPA增强MRI的动态强化方式（快进慢出）、肝胆期中心低或高信号伴外周高信号及ADC值可有效鉴别肝FNH和HCC。

Objective To explore the differentially diagnostic value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd⁃EOB⁃DTPA)⁃enhanced MRI between liver focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC). Methods The clinical data of 35 liver FNH patients (the liver FNH group) and 54 HCC patients (the HCC group) were retrospectively analyzed, and the imageology data of Gd⁃EOB⁃DTPA⁃enhanced MRI were compared between the two groups. The multivariate Logistic regression model was used to screen factors related to liver FNH. The receiver operating characteristic (ROC) curve was employed to analyze imaging features of Gd⁃EOB⁃DTPA⁃enhanced MRI for alone differentially diagnosing the value between liver FNH and HCC. Results The liver FNH group exhibited higher proportions of central scars, diffusion weighted imaging with low signal, dynamic reinforcement mode (fast⁃in and slow⁃out), hepatobiliary stage center with low or high signal and concomitant peripheral high signal, as well as a high apparent diffusion coefficient (ADC) value as compared with the HCC group (P<0.05). The results of multivariate Logistic regression analysis revealed that dynamic reinforcement mode (fast⁃in and slow⁃out), hepatobiliary stage center with low or high signal and concomitant peripheral high signal, and elevated ADC value were related to liver FNH (P<0.05). The results of ROC curve analysis indicated that areas under the curve of dynamic reinforcement mode (fast⁃in and slow⁃out), hepatobiliary stage center with low or high signal and concomitant peripheral high signal, and ADC value for differentially diagnosing liver FNH and HCC were 0.788, 0.864, 0.810, respectively, and the differential diagnosis efficiency of the 3 as above was similar. Conclusion Dynamic reinforcement mode (fast⁃in and slow⁃out), hepatobiliary stage center with low or high signal and concomitant peripheral high signal, and ADC value of Gd⁃EOB⁃DTPA⁃enhanced MRI can effectively perform differential diagnosis between liver FNH and HCC.

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