3.0T磁共振薄层动态增强序列评价肝细胞性肝癌的临床应用研究  

Value of Thin-Slice Fast Dynamic Contrast-Enhanced MRI Sequence on Diagnosis of Hepatocellular Carcinoma on 3.0T MRI System

作　　者：李迎春[1] 宋彬[2] 徐隽[3] 印隆林[1] 

机构地区：[1]四川省医学科学院.四川省人民医院放射科,成都610072 [2]四川大学华西医院放射科,成都610041 [3]四川省第四人民医院放射科,成都610016

出　　处：《中国普外基础与临床杂志》2008年第7期536-540,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨在3.0TMR平台上采用拢相位梯度回波肝脏加速容积采集序列(liver acceleration volume acquisition,LAVA)评价肝细胞性肝癌(hepatocellular carcinoma,HCC)的诊断价值。方法对20例CT或超声怀疑为HCC的患者,按顺序依次行MRI常规轴位的T2W和T1W平扫、3D-MRCP、钆剂增强的LAVA三期动态扫描和2D梯度回波T1W增强扫描。LAVA动脉期、门脉期和平衡期扫描数据采集分别于注射对比剂后15、55和90s进行,每期完成3次全肝扫描,而后行三维最大强度投影(maximum intensity projection,MIP)重建观察肝血管及病灶细微结构的显示情况。结果20例患者中共25个结节均经手术和病理证实为HCC,其中7个结节直径<1cm。3D-LAVA序列诊断HCC的敏感性及特异性分别为100%(25/25)和96%(24/25)。3D-LAVA序列显示24个结节出现动脉期强化,其中21个(21/25,84%)结节表现为"快进快出"的特征样强化方式,但24个结节动脉期强化峰值时间不同,5个位于动脉早期,11个位于动脉中期,8个位于动脉晚期。MIP重建图像清晰显示14个病灶的供血动脉和4个病灶的引流静脉以及病灶对邻近血管的推压(10个)和侵犯(3个)。结论3.0T磁共振薄层动态增强序列能够全面显示病灶的强化特征和细微形态特点,对诊断HCC具有重要价值。Objective To investigate the value of fast thin slice spoiled gradient-echo MR sequence known as the 3D liver acceleration volume acquisition （3D-LAVA） on diagnosis of hepatocellular carcinoma （HCC） on 3.0T MRI unit. Methods MRI scan was performed on 20 patients who were suspected of having HCC by CT or ultrasonography. The MRI scan protocol included routine axial T2WI and T1WI, 3D-MRCP, gadobenate dimeglumine enhanced 3D-LAVA in dynamic triple-phasic acquisitions at 15 s, 55 s and 90 s respectively, and enhanced 2D gradient echo （GRE） T1WI. The whole liver was scanned three times in each single phase of the 3D-LAVA sequence. 3D maximum intensity projection technique was used for image reconstructing and delineating the hepatic vessels and lesion details. Results Twenty patients with 25 HCC lesions were confirmed by surgery and pathology, among which 7 lesions were smaller than 1 cm in diameter. The sensitivity and specificity of 3D-LAVA sequence for the diagnosis of HCC were 100% （25/25） and 96% （24/25）. Altogether 24 HCC lesions demonstrated arterial-dominated enhancement, with 21 lesions （84%） showing ＂fast filling and rapid washout＂ features on 3D-LAVA images. But the peak enhancement appeared in different temporary windows, 5 in the early, 11 in the middle and 8 in the late arterial phase, respectively. The feeding arteries of 14 lesions, the draining veins of 4 foci, the displacement （10） and the infiltration （3） of the neighboring vessels were clearly displayed on 3D-MIP reconstructed images, respectively., Conclusion The contrast-enhanced fast thin-slice spoiled gradient-echo MR sequence on 3.0T MR system as exemplified by 3D-LAVA has very high sensitivity and specificity for the diagnosis of HCC, due to its ability to perform fast dynamic acquisitions and depict the morphological details of HCC lesions.

关 键 词：肝细胞肝癌 磁共振成像 动态扫描 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]