| Objective:Through the clinical diagnosis small hepatocellular carcinoma or suspicious small hepatocellular carcinoma patients of cirrhosis with,CT scan, CT perfusion imaging, diffusion-weighted imaging and MR dynamic scanning, evaluate the detectability of various checks on small lesions of the liver,comprehensive research on a wide variety of imaging contrast, evaluate diagnosis value of different imaging methods for small hepatocellular carcinoma.Materials and Methods: 42 patients of clinical diagnosis small hepatocellular carcinoma or suspicious small hepatocellular carcinoma patients underwent CT scan, CT Perfusion imaging, DWI and MR dynamic scanning. CT Perfusion using GE Lightspeed32 MSCT,contrast dose was 50ml,the injection rate was 5.0ml/s.CT enhanced scanning:The scan delay time for arterial phase, portal venous phase and lag phase was20 s, 60 s and 110s respectively. Injecting the contrast medium into the ulnar vein with the high– pressure syringe, the rate was 3ml/ s, and the dose was90ml. MRI scans using SIEMENS AVANTO 1.5T scanner, including T1WI,T2WI and diffusion weighted imaging. The DWI was performed with different b value(0 , 800s / mm2). The dynamic MRI examination with gadolinium-DTPA(Gd-DTPA) 0.1ml/kg, the rate was 3ml/ s.Two observers indepently interpreted the images of CT and MRI,separately, Including lesions of parts, size, density (signal) degree. CT Perfusion parameter values ,ADC values , Time-density curve type of lesions and cirrhotic liver parenchyma were measured .Results: 42 patients were checked out 52 lesions, the diagnosis of whieh inelude 41 casesOf SHCC,4 cases of dysplastic nodules ,7 cases of hemangioma.1 52 cases of SHCC were detected totally.in unenhance phase 35 SHCC presented hypoattenuated, 16 SHCC presented isoattenuated,1 SHCC presented hyperattenuated;in artery phase, 11 SHCC presented hypoattenuated, 10 SHCC presented isoattenuated,31 SHCC presented hyperattenuated ;in portal vein phase 30 SHCC presentedhypoattenuated, 17 SHCC presented isoattenuated,5 SHCC presented hyperattenuated and in delayed phase 41 SHCC presented hypoattenuated, 11 SHCC presented isoattenuated. The sensitivity of detection in unenhanced and three phases were 69.23%,80.77%,67.31%,78.85%.2 BF,BV,MTT,PS,HAF,HAP,HPP of SHCC was(270.792±168.110)ml.min-1,(22.713±10.298)ml.100g-1,(10.347±5.048)s,(41.752±25.408)ml.min-1.100g-1,0.810±0.231,181.986±148.230,48.805±85.780 respectively, BF,BV,MTT,PS,HAF,HAP,HPP BF,BV,MTT,PS,HAF,HAP,HPP of cirrhotic liver parenchyma was (181.990±136.763) ml.min-1,(18.232±8.848) ml.100g-1,(11.839±5.899)s,(41.270±16.081) ml.min-1.100g-1,0.323±0.250,62.983±96.138,119.007±121.189 respectively.SHCC's HAF and HAP higher than those of cirrhotic liver parenchyma ,HPP lower than rhotic liver parenchyma ( p < 0. 05) . Otherwise ,no significant difference was seen in the other perfusion parameters ( p > 0. 05). After a statistical approach to analysis of the ROC curve ,the diagnostic effectiveness of HAF was the best. Using the HAF value of 0. 642 as the diagnostic threshold ,the sensitivity and specificity reached88.9% and 88.9 % respectively.3 The Time-density curve had there types including rapid increase and rapid decrease, slowly initial, sustained enhancement. The type of rapid increase and rapid decrease was 10 cases which 9 SHCC and 1 benign lesion. The type of sustained enhancement was 16 cases which 15 SHCC and 1 benign lesion. The type of slowly initial was 7 cases which 3 SHCC and 4 benign lesion. Through statistical analysis there has relationship between the benign or malignant lesions and time-density curve type, the rapid increase and rapid decrease and sustained enhancement type is helpful to the SHCC's diagnosis.4 52 cases of SHCC were detected totally.49 lesions showed as hyperintense, 2 lesions showed as isointense,1 lesion showed as hypointense on DWI.15 lesions showed as hyperintense,10 lesion showed as isointense,27 lesions showed hypointense as onT1WI.38 lesions showed as hyperintense,8 lesion showed as isointense,6 lesions showed as hypointense onT2WI.The sensitivity of detection in DWI,T1WI and T2WI were 94.34%,79.25%,83.02%.5 The mean ADC value of SHCC,cirrhotic liver parenchyma,benign lesion was1.071±0.248×10-3mm2/s,1.185±0.273×10-3mm2/s ,1.490±0.562×10-3 mm2/s espectively.There was statistically significant difference in ADC value between SHCC lesions and cirrhotic liver parenchyma,SHCC lesions and benign lesion(p=0.005,p=0.017.When the ADC critical value of diagnosis benign and Malignant lesion was 1.176×10-3mm2/s,the sensitivity and specificity reached 70% and 81.2 % respectively.6 The Time-signal curve had there types including rapid increase and rapid decrease, slowly initial, sustained enhancement. The type of rapid increase and rapid decrease was 21 SHCC lesions. The type of sustained enhancement was 10 cases which 7 SHCC and 3 benign lesion. The type of slowly initial was 7 cases which 3 SHCC and 4 benign lesion.Through statistical analysis there has relationship between the benign or malignant lesions and time-density curve type, the rapid increase and rapid decrease and sustained enhancement type is helpful to the SHCC's diagnosis.7 the specificity and positive predice value of MR enhancement scanning was 80%,93.75% respectively. The specificity and positive predice value of union CT enhancement scanning and DWI,MR enhancement scanning and DWI was 90%,96.43% and 90%,96.55%,was higher than one method。But p>0.05.Conclusion:1 CT arterial phase imaging and delay phase imaging is useful for finging small lesions.2 CT perfusion imaging ,especially HAF measurement ,was helpful in detecting SHCC. Using the value of 0. 642 as the diagnostic hreshold ,the sensitivity and specificity of HAF reached 88.9%and 88.9% respectively.3 The Time-density(signal) curve had there types including rapid increase and rapid decrease, slowly initial, sustained enhancement.Through statistical analysis there has relationship between the benign or malignant lesions and time-density curve type, the rapid increase and rapid decrease and sustained enhancement type is helpful to the SHCC's diagnosis.4 The sensitivity of detection in DWI is higher than T1WI and T2WI.5 ADC values of malingnat tumors were lower than that of benign lesions. ADC value was helpful to differentiating malignant tumor from benign lesion. Using the value of 1.176×10-3 mm2/s as the diagnostic hreshold ,the sensitivity and specificity reached 70%and 81.2% respectively.6 The specificity and positive predice value of union CT enhancement scanning and DWI,MR enhancement scanning and DWI was higher than other methods,but can't think the diagnosis results of three methods and union diagnosis on malingnat and benign lesions have different。7 Clinical suspect small hepatocellular carcinoma patients can does MR enhancement scanning if economic circumstances allowed,DWI can as supplementary inspection technology.If patients'economic circumstances doesn't allowed,then can does CT enhancement scanning, difficult to diagnose then does DWI. |
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