| Part Ⅰ Feasibility evaluation research of the parameter values using Non-CE MR Perfusion Imaging (IVIM-DWI) in liverObjective:To optimize the scanning parameters and explore the application value of non-CE MR Perfusion Imaging(IVIM-DWI)in Hepatic lesions.Materials and Methods:85 patients with hepatic cyst, hepatic hemangioma, HCC (68men,17 women, mean age,48 years; range,31-67 years) underwent IVIM-DWI and conventional abdominal MRI. Sixb factors (0,50,100,150,200,600 sec/mm2) and eleven b factors (0,10,20,40,80,100,150,200,300,500,800 sec/mm2) were used in IVIM-DWI. Parameters values and maps were calculated by a 2 segment linear fitting algorithms written in matlab. The parameters included Apparent Diffusion Coefficient (ADC), pure diffusion coefficient (D), perfusion-related diffusion coefficient (D*) and perfusion fraction (PF).To compare the difference of the parameters values of the three hepatic lesions and of different numbers b value with IVIM-DWI. The nonparametric Kruskal-Wallis test were used for statistical analysis. Results:The patients were divided to Hepatic cyst 20 cases, hepatic hemangioma 21 cases, HCC 44 cases. The all parameters (D*, PF) in different hepatic lesions were significantly differences (P= 0.000). The ADC value is higher than D value in same lesion, but the two values were almost equality in hepatic cyst. The order of D* values were:HCC> hepatic hemangioma> hepatic cyst. PF values were: hepatic hemangioma> HCC> hepatic cyst. ADC and D values:hepatic cyst> hepatic hemangioma> HCC. The all parameters (ADC、D、D* and PF) from IVIM-DWI in different number b values were no differences (P= 0.279,0.473,0.178 and 0.642, respectively). But the standard deviation display that the accuracy of parameters values is higher in more numbers b values than less. Conclusion:IVIM-DWI had the ability to evaluate the microstructure and microcirculation functional status of hepatic lesions and provide effectively differential diagnosis. This technique is particularly applicable to patients who cannot receive intravenous gadolinium-based contrast media. It is very important for parameters accuracy of IVIM-DWI with effective number of lower b value scanning.Part Ⅱ Non-CE MR Perfusion Imaging (IVIM-DWI):the Value Study of Assessing the Microcirculation Function Status of Hepatocellular CarcinomaObjective:To investigate the assessment value for the microcirculation function status of hepatocellular carcinoma using IVIM-DWI. Materials andMethods:58 patients with HCC (49men,9 women mean age,50 years; range, 30-69 years) underwent IVIM-DWI and conventional abdominal MRI before operation. Six b factors (0,50.100.150,200,600 sec/mm2) and eleven b factors (0,10,20,40,80,100,150,200,300,500,800 sec/mm2)were used in IVIM-DWI. Parameters values and maps were calculated by a 2 segment linear fitting algorithms written in matlab. The parameters included Apparent Diffusion Coefficient (ADC), pure diffusion coefficient (D), perfusion-related diffusion coefficient (D*) and perfusion fraction (PF). Pathological results with Edmondson-Steiner’s classification were divided into two groups≤classⅡ,>classⅡ, and CD34 as a marker of HCC MVD calculation. The correlation was analysed between the perfusion parameters and pathological grade and MVD of hepatocellular carcinoma. The HCC were divided into three groups maximum diameter≤2cm,2cm<x≤3cm,> 3cm according to diameter size. The correlation between the IVIM-DWI parameters and tumor size were evaluated. Comparison and Correlation analysis adopted Wilcoxon and Spearman methods. Results:The pathological grade in 35 HCC patients were divided to type Ⅰ 8cases, type Ⅱ 30 cases, type in 20 cases, and no type IV. The parameters (D*, PF) were significantly positive correlated (r= 0.567 and 0.513, P= 0.000 and 0.000, respectively) and the parameters (ADC、D) were not correlated with MVD of HCC. In parameter map of D* showed red with higher perfusion degree. The parameters (ADC、D) was significantly negative correlated (r=-0.368 and -0.465, P=0.004 and 0.000) and the parameters (D*, PF) and tumour size of HCC were not correlated with pathological grade. Conclusion:IVIM-DWI had the ability to evaluate the microcirculation functional status of HCC patients. This technique is particularly applicable to patients who cannot receive intravenous gadolinium-basedPart Ⅲ Comparative study of evaluating the microcirculation function status of HCC between the Non-CE (IVIM-DWI) and CE (DCE-MRI) MR Perfusion ImagingObjective:To compare the difference of evaluating the microcirculation function status of HCC between IVIM-DWI and DCE-MRI with two-compartmental pharmacokinetic model. Materials and Methods:27 patients (22men,5 women, mean age,49 years; range,36-65 years) with HCC underwent IVIM-DWI and DCE-MRI before operation. DCE-MRI pharmacokinetic parameters values and maps were calculated using a two-compartmental model. IVIM-DWI parameters values and maps were calculated by a 2 segment linear fitting algorithms written in matlab. The DCE-MRI and IVIM-DWI perfusion parameters included volume transfer constant (Ktrans), extracellular extravascular volume fraction (Ve) Kep= (Ktrans/Ve), pure diffusion coefficient (D), perfusion-related diffusion coefficient (D*) and perfusion fraction (PF) and corresponding maps. Pathological results include Edmondson-Steiner’s classification divided into two groups≤classⅡ, >classⅡ and CD34 MVD. The correlation was analysed between the parameters and pathological grade and MVD of HCC. MVD can be divided into two groups according to value. The performance evaluation can be compared among the different parameters. Comparison and Correlation analysis adopted Wilcoxon and Spearman methods. Results:The pathological grade in the 27 HCC patients were divided to type Ⅰ 4 cases, type Ⅱ 14 cases, type Ⅲ 9 cases, and no type Ⅳ. The perfusion parameters (Ktrans, Kep, D*, PF) were significantly positive correlated (r= 0.892, 0.808,0.589 and 0.543, P= 0.000,0.000,0.001 and 0.003) and the parameter (D, Ve) were not correlated with MVD of HCC. That is the higher the degree of HCC microcirculation perfusion, the greater the parameters values. The parameter Ve and D values were no correlation with MVD; But the parameter Ve and D values were negatively correlated (r=-0.454 and -0.399, P= 0.017 and 0.039, respectively) with the pathological grade. The two parameters value declined with the pathological grade increased. In the evaluation MVD of HCC, the evaluation of the sensitivity and specificity performance in descending order is:Ktrans> Kep> PF> D*. In the evaluation pathological grade of HCC, the sensitivity and specificity is better by parameters D than Ve. Conclusion:DCE-MRI is better than IVIM-DWI for evaluation microcirculation functional status of HCC, but in pathological grade of HCC, IVIM-DWI is better than DCE-MRI. If combinate the two imaging techniques, can provide the more comprehensive evaluation in microcirculation functional status of the HCC. For the patients who can’t receive intravenous gadolinium-based contrast media, IVIM-DWI is the effective replace technique.Part IV CE MR Perfusion Imaging (DCE-MRI):the Value Study of Assessing the Microcirculation Function Status of Hepatocellular CarcinomaObjective:To investigate the diagnosis value for the microcirculation function status of HCC using DCE-MRI with two-compartmental pharmacokinetic model. Materials and Methods:44 patients with HCC (37men,7 women, mean age, 52 years; range,31-69 years) underwent DCE-MRI before operation. DCE-MRI pharmacokinetic parameters values and maps were calculated using a two-compartmental model. The DCE-MRI perfusion parameters included volume transfer constant(Ktrans), extracellular extravascular volume fractionC Ve)and(kep) =(Ktrans/Ve). Pathological results include the Edmondson-Steiner’s histological grade (Ⅰ.Ⅱ.Ⅲ.Ⅳ) and CD34 MVD. The correlation was analysed between the pharmacokinetic parameters and pathological grade and MVD of hepatocellular carcinoma. It is to be observed and analysed the shape of perfusion curve and the time to peak value for HCC and normal liver parenchyma. The parameters of HCC and liver parenchyma surrounding HCC were compared using Wilcoxon method. Results: The pathological grade in the 44 HCC patients were divided to type Ⅰ6 cases, type Ⅱ 24 cases, type Ⅲ 14 cases, and no type IV. The perfusion parameters (Ktrans, Kep) was significantly positive correlated (r= 0.881 and 0.746, P= 0.000) and the parameter (Ve) was not correlated with MVD of HCC. In parameter map of Ktrans and Kep, the red deeper the higher perfusion degree. The perfusion parameter (Ve) was significantly negative correlated (r=-0.371, P=0.013)and the parameters (Ktrans, Kep) and MYD were not correlated with pathological grade of HCC. DCE perfusion imaging showed that the perfusion curve the vast majority of the HCC patients was a sudden jump in sudden drop, a small part was a sudden jump in gradual decline. HCC perfusion peak time confined to late arterial phase 23.1s-34.2s, and in the period 42.2s-57s, is the normal liver parenchyma first time to peak. The parameters (Ktrans, Kep) values of HCC were significantly higher, and parameter (Ve) was significantly lower than the surrounding liver parenchyma. Conclusion:DCE-MRI using two-compartmental pharmacokinetic model can be evaluate accurately the HCC microcirculation status in vivo, And provide the reliably diagnosis Combinated morphological and functional aspect. |
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