慢性肝病背景下钆塞酸二钠肝胆期成像对肝癌的检出与定性  

Hepatobiliary phase imaging with Gd-EOB-DTPA for detection and characterization of hepatocellular carcinoma in patients with chronic liver disease

作　　者：叶枫[1] 宋颖[1] 余小多[1] 张红梅[1] 欧阳汉[1] 吴宁[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院影像诊断科,北京100021

出　　处：《中国医学影像技术》2015年第4期571-575,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨钆塞酸二钠（Gd-EOB-DTPA）肝胆期成像在慢性肝病背景下对肝癌检出和定性的价值。方法回顾性分析99例慢性肝病患者的Gd-EOB-DTPA增强MRI表现,89例患者经临床诊断或病理诊断有肝癌病灶,10例患者临床诊断未见明确异常,作为阴性对照。所有MR图像数据,由2名高年资医师共同阅片,分析肝胆期图像与DWI对肝癌的检出率;另由3名中低年资医师将其分为有肝胆期组和无肝胆期组,并对两组图像独立盲法阅片,比较两组图像肝癌病灶的检出率、诊断信心分值及ROC曲线。组间结果的比较采用Wilcoxon或McNemar非参数检验。结果 89例肝癌患者共检出130个病灶,其中肝癌病灶111个,良性结节19个,111个肝癌病灶中100个经病理证实,11个临床诊断。肝胆期成像对肝癌的检出率高于DWI[99.10%（110/111）vs 90.99%（101/111）,P=0.012];有肝胆期组阅片者平均信心分值明显高于无肝胆期组（P=0.001）;对于长径≤1cm的小肝癌,有肝胆期组平均检出率高于无肝胆期组[93.00%（17.67/19）vs 70.16%（13.33/19）,P=0.016];有肝胆期组ROC曲线下面积亦高于无肝胆期组[0.949（95%CI：0.815~0.995）vs 0.744（95%CI：0.566~0.877）,P=0.0023]。结论慢性肝病背景下应用Gd-EOB-DTPA的肝胆期图像的肝癌检出率优于DWI,尤其对于长径≤1cm的小肝癌,同时能够提高诊断信心。Objective To evaluate hepatobiliary phase（HBP）imaging with Gd-EOB-DTPA for detection and characterization of hepatocellular carcinoma（HCC）in patients with chronic liver disease.Methods Totally 99 patients with chronic liver disease who underwent Gd-EOB-DTPA MR examinations were analyzed retrospectively,89 patients were clinically or pathologically diagnosed as HCC,and 10 patients were clinically diagnosed as normal to serve as a control.The ability of HBP and DWI in detection of HCC were compared by two senior radiologists.Another 3junior and medium grade radiologists independently reviewed each examination with and without HBP.Lesion detection,confidence scores and area under the ROC curve（AUC）were compared.Statistical comparisons of the rated results were made by using Wilcoxon test or McNemar＇s Chi-square test.Results A total of 130 nodules were diagnosed as HCC（n=111）and benign（n=19）,100 HCCs were proved by pathology and 11 HCCs were clinically diagnosed.HBP had a higher detection rate for HCCs than DWI（99.10% [110/111]vs 90.99% [101/111],P=0.012）.With the inclusion of the HBP,lesions detection was improved（93.00% [17.67/19]vs 70.16% [13.33/19],P=0.016）for HCCs≤1cm in size and mean confidence scores significantly increased（P=0.001）.For lesions≤1cm in size,the diagnostic performance improved with the addition of the HBP（AUC 0.949 [95%CI 0.815~0.995]vs 0.744 [95%CI 0.566~0.877],P=0.0023）.Conclusion HBP with GdEOB-DTPA has a superior sensitivity than DWI.It may improve the detection rate and the diagnosis confidence of HCCs≤1cm in patients with chronic liver disease.

关 键 词：磁共振成像 钆塞酸二钠 肝胆期 慢性肝病 癌 肝细胞 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]