3.0T下肝细胞癌同时多层扩散加权成像：屏气、自由呼吸与呼吸触发技术比较
前瞻性纳入172例肝细胞癌患者（189个病灶），比较3.0T下屏气、自由呼吸和呼吸触发SMS-DWI的图像质量与ADC可重复性。自由呼吸SMS-DWI被推荐为最可靠高效的临床选择；屏气SMS-DWI ADC可重复性最高，适合治疗监测和纵向随访。
要点
- 自由呼吸SMS-DWI图像质量与呼吸触发相当，推荐作为临床HCC成像的可靠高效选择。
- 屏气SMS-DWI扫描时间最短且ADC可重复性最高，适合治疗监测和纵向随访。
- 三种呼吸方案获得的肿瘤ADC值无显著差异。
核心结论
- 自由呼吸SMS-DWI被推荐为临床HCC成像最可靠高效的选项。
- 屏气SMS-DWI具有最优ADC可重复性，适用于屏气能力充分患者的治疗监测和纵向随访。
研究设计与样本
- 所有患者接受屏气、自由呼吸和呼吸触发SMS-DWI，b值取50、400、800 s/mm²。
- 图像质量采用5点Likert量表定性评估，并定量测量SNR、CNR和ADC值。
- 每种呼吸方案重复扫描两次以评估ADC可重复性，采用ICC和TRV评价。
关键影像表现/征象
- b=800 s/mm²时，屏气SMS-DWI整体图像质量评分（3.37±0.67）显著低于呼吸触发（3.65±0.69）和自由呼吸（3.63±0.65），后两者无显著差异。
- 屏气SMS-DWI肝脏和肿瘤SNR均显著低于呼吸触发和自由呼吸方案。
- 三种呼吸方案的肿瘤ADC值无显著差异。
诊断标准与关键数值
- 屏气SMS-DWI的ADC可重复性最高：ICC 0.86（95%CI 0.84-0.91），TRV 9.17（95%CI 7.21-16.23）。
- 自由呼吸SMS-DWI：ICC 0.83（95%CI 0.76-0.87），TRV 14.27（95%CI 11.34-21.17）。
- 呼吸触发SMS-DWI：ICC 0.80（95%CI 0.75-0.86），TRV 14.36（95%CI 12.57-23.31）。
临床应用与阅片要点
- 临床HCC成像可优先选用自由呼吸SMS-DWI，兼顾图像质量与效率。
- 治疗监测和纵向随访若患者屏气能力充分，可选用屏气SMS-DWI以获得更高的ADC可重复性。
- 高b值（b=800 s/mm²）时屏气SMS-DWI图像质量和SNR下降，判读需注意。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: This study aimed to evaluate the performance of simultaneous multi-slice diffusion weighted imaging (SMS-DWI) using breath-hold (BH), free-breathing (FB), and respiratory-triggered (RT) breathing schemes in patients with hepatocellular carcinoma (HCC), focusing on image quality and apparent diffusion coefficient (ADC) repeatability.
METHODS: This prospective study consecutively enrolled HCC patients between October 2020 and March 2023, based on specific inclusion and exclusion criteria. The patients underwent BH-SMS-DWI, FB-SMS-DWI and RT-SMS-DWI at b-values of 50, 400, and 800 s/mm2. Image quality was assessed qualitatively using a 5-point Likert scale. Besides, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and ADC values were quantitatively measured. To evaluate the ADC repeatability, SMS-DWI scans were performed twice for each breathing scheme. The intraclass correlation coefficient (ICC) and test-retest variability (TRV) were used for assessment.
RESULTS: A total of 172 HCC patients with 189 HCC lesions were included for analysis. BH-SMS-DWI showed the shortest scan time but reduced image quality at high b-values (b = 800 s/mm2) compared to RT-SMS-DWI and FB-SMS-DWI. At b = 800 s/mm2, BH-SMS-DWI exhibited significantly lower overall image quality (3.37 ± 0.67, P < 0.001) compared to both RT-SMS-DWI (3.65 ± 0.69) and FB-SMS-DWI (3.63 ± 0.65), with no significant difference between them (P > 0.990). In addition, it also demonstrated inferior SNRs for both liver and tumor compared to RT-SMS-DWI (liver: 118.36 vs. 183.08, P < 0.001; tumor: 247.41 vs. 389.23, P < 0.001) and FB-SMS-DWI (liver: 118.36 vs. 161.52, P < 0.001; tumor: 247.41 vs. 323.48, P < 0.001). There were no significant differences in tumor ADC values across three breathing schemes. BH-SMS-DWI demonstrated the highest ADC repeatability (ICC: 0.86, 95% CI: 0.84-0.91; TRV: 9.17, 95% CI: 7.21-16.23), followed by FB-SMS-DWI (ICC: 0.83, 95% CI: 0.76-0.87; TRV: 14.27, 95% CI: 11.34-21.17), and RT-SMS-DWI (ICC: 0.80, 95% CI: 0.75-0.86; TRV: 14.36, 95% CI: 12.57-23.31).
CONCLUSION: FB-SMS-DWI is recommended as the most reliable and efficient option for clinical HCC imaging. BH-SMS-DWI, with superior ADC repeatability, is preferred for treatment monitoring and longitudinal follow-up in patients with sufficient breath-holding capability.
引用
- Zhang M, Li H, Yang T, et al. Simultaneous multi-slice diffusion weighted imaging of hepatocellular carcinoma at 3.0 T: Comparison of breath-hold, free-breathing, and respiratory-triggered techniques. Eur J Radiol. 2026. PMID: 42139803. doi:10.1016/j.ejrad.2026.112927
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。