The Applied Research Of Magnetic Resonance Spectroscopy In The Diagnosis And Identification Of Hepatocellular Carcinoma

Backgroud:Magnetic resonance spectroscopy(MRS) is currently the only non-invasive magnetic resonance imaging technique, which can detect metabolite compositions of in vivo organs and tissues, and also able to carry out semi-quantitative or quantitative analysis. In China,the incidence of primary liver cancer is high, secondly only to gastric cancer and esophageal cancer, in which hepatocellular carcinoma (HCC) accounts for above 90%.HCC has a short course, rapid development, but high mortality. The early symptoms of the disease are not obvious. To late symptoms, patients often have no the best chance to treat,and the majority of this patients are poor prognosis. Therefore, The main way to improve the survival rate of this patients is early detection, early diagnosis and early treatment to hepatocellular carcinoma, in use of various diagnostic techniques. Liver biopsy diagnosis is a "gold standard" for diagnosis of hepatocellular carcinoma, but it has some shortcomings, such as invasive and easily have the risk of metastasis near the edge of the liver caused by liver rupture, and so on, witch limit its wide application in liver diseases. Therefore, it was an urgent need to improve the HCC and other focal hepatic lesions in diagnostic accuracy,using a non-invasive inspection techniques. As an in vivo non-invasive diagnostic tool, The clinical application of MRS has provided us with a reliable guarantee. In this study, we will study larger HCC and other focal lesions, using single voxel proton magnetic resonance spectroscopy(1H-MRS). We look forward to provide some valuable information for the diagnosis and differential diagnosis of HCC.Purpose:â‘ To observe the metabolite compositions and characteristics in normal liver from spectrums, and also to explore what the echo time (TE) impact on the quality of spectrals and metabolite compositions;â‘¡To analyse the features of choline (Cho)peak and the glycogen complex(GLyu) peak in HCC and benign liver tumors, using 1.5T 1H-MRS;â‘¢Totry to observe, analyze and summarize crest morphology of HCC and benign liver tumors,applying single voxel 1H-MRS;â‘£Based on the above, to analyse the value in diagnosis and differential diagnosis of HCC, using 1H-MRS.Methods:20 healthy volunteers (control group),25 HCC patients (HCC group) and 22 patients with benign liver tumors (benign liver tumor group,6 liver adenomas patients,3FNH patients and 13 hemangiomas patients), who are examined by 1.5T MR before treatment. The healthy volunteers are examined three times (TE were collected from 35ms,90ms,144ms). and we will analyse the quality of spectrums; we will observe the crest morphology of HCC and benign liver tumors, and also observe the features of Cho peak and the Glyu peak in HCC and benign liver tumors.Results:â‘ With the increase in TE (respectively,35ms,90 ms,144 ms), the Cho peak is gradually increased, Lip2 peak height have no significant changes, and the quality of spectrums gradually decline.â‘¡Some of HCC have significantly elevated Cho peak, some have mildly elevated Cho peak, and only one have not elevated Cho peak. The Cho peak and Glyu peak of Benign vascular tumors and liver adenomas are not obvious. The Cho peak of 3 FNH increase, in which 2 Glyu peaks increase.â‘¢The incidence of I type ("M" type) waveform in HCC group is higher than benign liver tumor group, and the difference was significant (P<0.01).2 FNH can see "M"-type peak.Conclusion:â‘ It is feasible that 1H-MRS is used in the liver. Using appropriate scanning method can be of higher quality spectrums when TE=35ms.â‘¡Elevated Cho peak prompte the diagnosis of HCC, and HCC often accompany elevated Glyu peak. And These features can identify with hemangioma and hepatic adenoma, but difficulties in identification of FNH.â‘¢HCC and benign liver tumors have significantly different in 1H-MRS waveform. HCC and benign liver tumors can be distinguished by observing the spectrums (P<0.01).1H-MRS waveform characteristics of HCC:Elevated Cho peak and Elevated Glyu form "M"-type peak. Hepatic hemangioma 1H-MRS waveform characteristics:Lip2 peak is obvious, other peaks are not obvious, which form the "single-peak."â‘£1H-MRS can be used for the diagnosis and identification of HCC, despite have some shortcomings, but after all, in compatible with conventional MR, 1H-MRS is a better way to check.