CAJ | 학술논문

目的：探讨DWI评价肝脏泡状棘球蚴病（HAE）生物学活性的价值。方法回顾性分析经手术病理证实为HAE且同时行MR DWI和PET-CT检查的8例患者资料。分别观察DWI和PET-CT表现，并根据DWI和PET-CT结果对HAE病灶的活性进行定性评估。对DWI和PET-CT结果进行两个等级（秩）变量间的一致性分析，计算Kappa值。结果8例HAE患者共检出16个病灶，其中HAE病灶14个，囊性包虫病灶2个。（1）DWI表现：14个HAE中，9个最大径≥2 cm，其中8个HAE病灶边缘可见高信号带，分布在病灶与正常肝组织交界区，1个经药物治疗后病灶可见周边断续稍高信号带；5例最大径<2 cm病灶表现为结节状高信号区。2个囊性包虫病灶在DWI上为等或稍低信号。（2）PET-CT表现：14个HAE病灶中，13个显示18F脱氧葡萄糖（18F-FDG）呈不同程度摄取，其中8个最大径≥2 cm的病灶表现为病灶中央充盈缺损，在病灶与正常肝实质交界区出现18F-FDG高浓聚区；5个最大径<2 cm的病灶表现为结节状18F-FDG摄取。2个囊性包虫在PET-CT中无明显18F-FDG摄取，表现为肝脏内及脾门区局限性充盈缺损。DWI和PET-CT对病灶活性评估的一致性好（Kappa=0.880，P=0.006）。结论 DWI可以较好地在体反映HAE的生物学活性。
목적：탐토DWI평개간장포상극구유병（HAE）생물학활성적개치。방법회고성분석경수술병리증실위HAE차동시행MR DWI화PET-CT검사적8례환자자료。분별관찰DWI화PET-CT표현，병근거DWI화PET-CT결과대HAE병조적활성진행정성평고。대DWI화PET-CT결과진행량개등급（질）변량간적일치성분석，계산Kappa치。결과8례HAE환자공검출16개병조，기중HAE병조14개，낭성포충병조2개。（1）DWI표현：14개HAE중，9개최대경≥2 cm，기중8개HAE병조변연가견고신호대，분포재병조여정상간조직교계구，1개경약물치료후병조가견주변단속초고신호대；5례최대경<2 cm병조표현위결절상고신호구。2개낭성포충병조재DWI상위등혹초저신호。（2）PET-CT표현：14개HAE병조중，13개현시18F탈양포도당（18F-FDG）정불동정도섭취，기중8개최대경≥2 cm적병조표현위병조중앙충영결손，재병조여정상간실질교계구출현18F-FDG고농취구；5개최대경<2 cm적병조표현위결절상18F-FDG섭취。2개낭성포충재PET-CT중무명현18F-FDG섭취，표현위간장내급비문구국한성충영결손。DWI화PET-CT대병조활성평고적일치성호（Kappa=0.880，P=0.006）。결론 DWI가이교호지재체반영HAE적생물학활성。
Objective To evaluate DWI in the assessment of viability of hepatic alveolar echinococcosis (HAE) by comparing DWI with PET-CT results. Methods 18-fluorodeoxy glucose(18F-FDG) PET-CT and DWI(b values=0, 800 s/mm2) were retrospectively analyzed in 8 patients with clinically verified HAE. The metabolic activity of HAE lesions in both techniques were determined by two independent radiologists respectively. Kappa test was assessed between the results of two observers. Results Sixteen lesions (composed of 14 HAE and 2 cystic echinococcosis, CE) were detected. (1)Eight lesions (≥2 cm) showed perilesional hyper-signal intensity on DWI, mainly around the lesion bounding by normal liver parenchyma. One patient (≥2 cm) had oral drug therapy for three years, and the lesion showed discontinuous perilesional hyper-signal intensity on DWI after the therapy. Five lesions (<2 cm) were depicted as nodular high signal on DWI.(2)Eight lesions (≥2 cm) showed perilesional increased FDG uptake on PET-CT, while 5 lesions (<2 cm) displayed as“hot pot”. One patient (leison≥2 cm) who had oral drug therapy for three years showed hepatic defect without any FDG uptake in post-treatment PET-CT. Two CE lesions showed negative results on both DWI and PET-CT. The Kappa value of 0.880 indicated a good coincidence between DWI and PET-CT in depicting the metabolic activity of HAE (P=0.006). Conclusions This preliminary study showed the value of DWI in assessing HAE viability. DWI should be routinely used as one of the techniques in the evaluation of HAE.