Comparison And Combined Application Of Multimodality Technique Of CT And MR In Hepatic Disease

Part 1 Comparison of the ADC values of abdominal organs using different bvalues by MR diffusion weighted imagingObjective: To investigate the difference of the apparent diffusion coefficient (ADC)values of abdominal organs using different b values by MR diffusion weightedimaging.Methods: MR diffusion weighted imaging(DWI) were performed on 29 cases,including 17 normal volunteers and 12 malignant liver lesions(6 hepatocellularcarcinoma, 2 cholangiocellular carcinoma and 4 metastasis tumors). Each casesunderwent twice DWI using b=0, 500, 1000 s/mm² and b=0, 200, 400 s/mm²respectively. Comparison of the two ADC values of each abdominal organs and livermasses got under the two different b values.Results: When b=0, 500, 1000 s/mm², ADC value of normal liver was (1.50±0.11)× 10^-3mm²/s, range from 1.14 to 1.67(× 10^-3mm²/s);when b, 200, 400 s/mm², theADC value was (1.13±0.19)X 10^-3mm²/s, from 0.59 to 1.42(X 10^-3mm²/s). Theformer was significantly higher then the latter(t=6.058, P=0.0001), and also morestable. As spleen, pancreas and 12 liver tumors as concerned, the ADC values gotunder b=0, 500 , 1000 s/mm² were also significantly higher then the results got underb=0, 200, 400 s/mm²(P<0.05).Conclusion: For DWI, b value could effect the ADC values of abdominal organs andlesions, the result got using high b value was more accurate and more stable than thatusing low b value.Part 2 Comparison of hepatic perfusion between CT and MR perfusionevaluationObjective: To compare the time to peak(TTP) and the steepest slope(SS) of hepaticparenchyma, other organs and liver lesions between the results of CT and MRperfusion, and investigate the correlation between CT and MR results.Methods: 50 cases underwent CT and MR perfusion, including 11 normal volunteers, 16 cirrhosis, 13 malignant liver lesions(5 hepatocellular carcinoma, 4 cholangiocellular carcinoma and 4 metastasis tumors) and 10 benign lesions(4 hemangioma, 1 hepatocellular adenoma, 2 inflammatory node and 3 liver abscess). Draw a region of interest(ROI) within liver parenchyma, aorta, spleen and liver masses, then get their time-density curve(TDC) and time-intensity curve(TIC), calculate the TTP and SS of each ROI, compare the results between CT and MR perfusion.Results: The TTP of liver, spleen and 23 liver lesions of CT perfusion was (53.51±10.83)s, (31.02±3.86)s, and (62.44±11.20)s, respectively. Those of MR result was (53.49±11.41)s, (30.65±5.44)s, and (58.08±10.21)s, respectively. There is no significant difference between CT and MR result. While when the SS of each ROI is concerned , there was a satisfactory correlation between the results got from TDC and TIC.Conclusion: To evaluate the TTP and SS of hepatic parenchyma and liver lesions, there was a satisfactory correlation between CT and MR perfusion.Part 3 Comparison of differential diagnosis value of CT perfusion, MR perfusion and DWI in benign lesion, malignant lesion, cirrhosis and normal liver Objective: To compare the differential diagnosis value of CT perfusion, MR perfusion and DWI in benign lesion, malignant lesion, cirrhosis and normal liver. Methods: 110 cases underwent DWI including 17 volunteers, 16 cirrhosis, 37 malignant liver lesions(21 hepatocellular carcinoma, 7 cholangiocellular carcinoma and 9 metastasis tumors) and 40 benign lesions(12 hemangioma, llcystes, 3 focal nodular hyperplasia, 1 hepatocellular adenoma, 5 inflammatory necrotic node or granuloma and 8 liver abscess). DWI scan used the same parameters offered in Part l(b=0> 500> 1000 s/mm2). Among the 110 cases, 50 cases(the same as Part 2) underwent CT perfusion and MR perfusion. Separate the perfusion curve of liver lesion and hepatic parenchyma into two parts according to the TTP of spleen,calculate the SS of each part, then get the ratio of the two SS, named [ SSr(ct)=SS ?, /SS e ] to CT perfusion and [SSr(mr)=SS m/SS s ] to MR perfusion. The ratio could represent the ratio of hepatic artery flow and portal vein flow.Results: The ADC value of benign lesion, malignant lesion, cirrhosis and normal liver was(2.21±0.74)X10"3mm2/s, (1.02±0.15)X10"3mm2/s, (1.33±0.12)X10"3mm2/s and (1.50+0.11) X10"3mm2/s? respectively. The difference between each 2 groups were significant(P<0.05), except the result between cirrhosis and normal liver(P>0.05). The SSr(ct) and SSr(mr) of normal liver: 0.72±0.26 and 0.66±0.24, as to cirrhosis, the results were 1.38±0.39 and 1.83±0.59, the result of benign lesions were 1.26±0.41 and 1.19±0.36, results of malignant tumors were 1.52±0.60 and 1.79±0.35. The difference between each 2 groups were not significant(P>0.05), except the result between cirrhosis and normal liver, and the result between malignant tumors and normal liver(P<0.05).Conclusion: To different benign from malignant lesion, cirrhosis from those benign or malignant lesions, DWI may has more advantage than CT and MR perfusion, while CT and MR perfusion has more advantage in the diagnosis of cirrhosis.Part 4 Comparison of differential diagnosis value of CT perfusion, MR perfusion and DWI in different severity cirrhosisObjective: To compare the differential diagnosis value of CT perfusion, MR perfusion and DWI in different severity cirrhosis.Methods: 27 cases underwent CT, MR perfusion and DWI including 11 volunteers and 16 cirrhosis. According to the degree of their liver function, 7 patients of cirrhosis belong to group of cirrhosis l(Child-Pugh A), 9 patients of cirrhosis belong to group of cirrhosis 2(6 cases were Child-Pugh B, the other 3 were Child-Pugh C). Compare the ADC value, SSr(ct) and SSr(mr) between cirrhosis 1, cirrhosis 2 and normal liver. Results: The ADC value of the 3 group(cirrhosis 1, cirrhosis 2 and normal liver) was(1.35±0.12)Xl(r3mm2/s, (1.32±0.16)Xl()-3mm2/s and (1.52±0.31)Xl(r3mm2/s, respectively. The SSr(ct) of the 3 groups was (0.95±0.28), (2.01 ±0.66) and (0.72±0.26). While the SSr(mr) was (1.17±0.49), (2.31±0.76) and (0.66±0.24),respectively. The ADC values of 2 cirrhosis groups were lower than normal group, but the difference were not significant(P>0.05), also the result between cirrhosis 1 and cirrhosis 2(P>0.05). As to the results of SSr(ct) and SSr(mr), results of cirrhosis 2 were significantly higher than cirrhosis 1 group and normal group (P<0.05), but the result between cirrhosis 1 and normal liver was not significant(P>0.05). Conclusion: CT and MR perfusion has more advantage than DWI to evaluate cirrhosis, perfusion evaluation could reflect the blood flow of cirrhosis, and the result: SSr(ct) and SSr(mr) also could reflect the severity of cirrhosis.Part 5 Differential diagnosis value of CT perfusion, MR perfusion and DWI in different kinds of malignant liver lesions and some inflammatory lesions Objective: To compare the differential diagnosis value of CT perfusion, MR perfusion and DWI in different kinds of malignant liver lesions and some inflammatory lesions.Methods: 18 patients underwent CT, MR perfusion and DWI scan. They were divided into 4groups: 5 hepatocellular carcinoma, 4 cholangiocellular carcinoma, 4 metastasis tumor and 5 inflammatory lesions (2 inflammatory node and 3 liver abscess). Compare the ADC value, SSr(ct) and SSr(mr) between the 4 groups. Results: The ADC value of hepatocellular carcinoma, cholangiocellular carcinoma and metastasis tumor was(1.00±0.12) X 10"3mm2/s, (1.29±0.32) X 10'W/s, and (1.07±0.14) X 10'3mm2/s, respectively. The results of cholangiocellular carcinoma were significantly higher than hepatocellular carcinoma and metastasis tumor (P<0.05), but the difference between hepatocellular carcinoma and metastasis tumor was not significant(P>0.05). The ADC value of inflammatory lesions was (1.49±0.33) X 10"3mm2/s, the result was significantly higher than hepatocellular carcinoma and metastasis tumor (P<0.05), but the difference between inflammatory lesions and cholangiocellular carcinoma was not significant(P=0.097). The SSr(ct) and SSr(mr) of the 4 groups were: 2.53±0.47 and 3.20±0.82,0.99+0.18 and 0.98±0.28,0.90±0.43 and 0.94±0.46, 1.47±0.50 and 1.39±0.42, respectively. The results of metastasis tumor was significantly lower than those of hepatocellular carcinoma(P<0.05). Thedifference between metastasis tumor and cholangiocellular carcinoma was not significant(P>0.05), neither of the difference between hepatocellular carcinoma and cholangiocellular carcinoma. Either the SSr(ct) or SSr(mr) of inflammatory lesions was significantly higher than those of metastasis tumor, but significantly lower than those of hepatocellular carcinoma(P<0.05). The difference between inflammatory lesions and cholangiocellular carcinoma was not significant(P<0.05). Conclusion: CT and MR perfusion has more advantage than DWI in the evaluation of hepatocellular carcinoma and metastasis tumor. To the differential diagnosis of inflammatory lesions(especially liver abscess) and cholangiocellular carcinoma, neither CT and MR perfusion nor DWI has advantage, the diagnosis should be carefully made.Part 6 The combination diagnosis values of CT perfusion, MR perfusion andDWI in liver diseaseObjective: Combine the common image with function image, to investigate thediagnosis values of function evaluation (including CT perfusion, MR perfusion andDWI) in liver disease.Methods: 15 patients, couldn't got a confidence diagnosis with common CT and/orMR images, underwent function scan. 9 of them were patients with hepatocellularcarcinoma, 3 after surgical ectomy, 6 after one of the 3 methods: transcatheterarterial chemoembolization(TACE), PRFA, and PEL The other 4 patients hadmultiple lesions in liver. The other 2 patient, one has an atypical liver cyst, the otherhas an atypical hemangioma.Results: When combine the function evaluation include CT perfusion, MR perfusionand DWI, all 15 patients got a diagnosis more confirm than common images. On theother hand, 3 patients with liver multiple lesions, we could found more lesions withDWI than common images.Conclusion: Function evaluation include CT perfusion, MR perfusion and DWI,combine with common CT or MR images, could improve both diagnostic accuracyand the ability of detection in liver disease.