CT增强与Gd—EOB—DTPA MR增强扫描对肝细胞肝癌诊断价值的对比分析  

Comparison of multiphasic CT and Gd-EOB-DTPA enhanced MRI in diagnosing hepatocellular carcinoma

作　　者：柴超[1] 范文骏[1] 夏爽[2] 季倩[2] 沈文[2] 

机构地区：[1]天津医科大学-中心临床学院放射科,天津300192 [2]天津市第一中心医院放射科

出　　处：《实用放射学杂志》2013年第12期1953-1958,1962,共7页Journal of Practical Radiology

摘　　要：目的回顾性对比分析CT增强及Gd—EOB-DTPAMR增强扫描对肝细胞肝癌（HCC）的诊断价值。方法临床疑诊为HCC的患者47例共94个病灶纳入本研究，其中26例共63个病灶经病理、临床或随访证实为HCC。所有患者均行CT增强及Gd—EOB-DTPAMR增强检查，3位观察者分别对CT及MR增强、MR增强（含肝胆期）图像进行独立分析诊断。采用替代自由响应受试者操作工作特性（alternative free—response receiver operating characteristic，AFROC）曲线对3种检查方法诊断结果的准确性（曲线下面积，AUC）进行分析。同时，计算3种检查方法诊断结果的灵敏度及阳性预测值，并采用McNemar检验对其进行对比分析。结果3位观察者的观测结果均显示，CT与MR增强检查对所有病灶诊断的AUC均小于MR增强（含肝胆期）检查（P〈0．05）；MR增强（含肝胆期）检查诊断HCC的灵敏度高于CT增强检查（P〈0．05）。直径≤1cm的病灶，其中1位观察者的结果显示，MR增强（含肝胆期）诊断HCC的灵敏度高于CT及MR增强检查（P〈0．05）。结论与CT和MR增强检查相比，Gd—EOB-DTPAMR增强检查能明显提高对HCC诊断的准确性及灵敏度，尤其对于直径≤1cm的病灶。Objective To retrospectively compare the diagnostic value of multiphasic enhanced CT with Gd-EOB-DTPA enhanced MRI in detection of hepatocellular carcinoma （HCC）. Methods A total of 47 patients with 94 lesions suspected HCCs were included in this study, 26 of whom with 63 lesions were confirmed as HCCs by pathology, clinical comprehensive analysis or follow-up. All patients underwent both muhiphasic enhanced CT and Gd-EOB-DTPA enhanced MR examinations. Three observers independently analyzed the images including enhanced CT images, dynamic enhanced and Gd-EOB-DTPA enhanced MRI respectively and made the diagnosis. The alternative free-response receiver operating characteristic （AFROC） method was used to analyze the diagnostic accu- racy（area under curve, AUC）of three protocols. Meanwhile, sensitivity and positive predictive values were calculated and compared by using McNemar test. Results The results of three observers showed that the AUC of both multiphasic enhanced CT and dynamic enhanced MRI were significantly lower than that of combined interpretation of dynamic and hepatobiliary phase MR images for all lesions （P〈0.05）. Meanwhile, the sensitivity of combined interpretation of dynamic and hepatobiliary phase MR images was significantly higher than that of multiphasic enhanced CT （P〈0.05）. For lesions less than 1 cm in diameter,the result of one observer showed that the sensitivity of combined interpretation of dynamic and hepatobiliary phase MR images was significantly higher than that of both muhiphasic enhanced CT images and dynamic enhanced MR images（ P〈0.05）. Conelusion Compared with multiphasic enhanced CT and dynamic enhanced MRI, Gd-EOB-DTPA enhanced MRI can obviously improve the accuracy and sensitivity in diagnosis of HCC, especially for lesions less than 1 cm in diameter.

关 键 词：肝细胞肝癌 对比剂 计算机体层成像 磁共振成像 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]