T2WI、DWI及Gd-EOB-DTPA增强扫描独立序列对结直肠癌肝转移瘤检出率的比较  

Comparison of T2-weighted,diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging alone for detection of colorectal liver metastases

作　　者：姜军[1] 叶枫[1] 赵宏[1] 李颖[1] 蒋力明[1] 欧阳汉[1] 

机构地区：[1]中国医学科学院北京协和医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6期880-884,共5页Chinese Journal of Medical Imaging Technology

基　　金：首都卫生发展科研专项(首发2014-1-4022)

摘　　要：目的比较T2WI、DWI及Gd-EOB-DTPA增强扫描单独序列对结直肠癌肝转移瘤的检出效能。方法选取31例结直肠癌肝转移患者,均行MR检查,包括T2WI/FS、DWI、Gd-EOB-DTPA常规动态增强（MR-Dyn）和肝细胞期（MR-Late）扫描。由2名医师共同阅片,对每组影像图像进行单独分析。记录所有检出病灶所在层面、肝段、与肝脏边缘的距离及病变大小。以手术病理、术中超声及治疗前后影像图像的综合评价作为金标准。采用配对McNemar检验比较各序列对肝转移瘤的检出率。结果 31例患者中,共检出156个肝转移瘤,大小0.3-7.3cm,≤0.5cm、0.6-1.0cm、1.1-2.0cm和〉2.0cm分别为20、52、50和34个。对肝转移瘤的总体检出率,T2WI/FS、DWI、MR-Dyn和MR-Late分别为84.62%（132/156）、87.18%（136/156）、67.31%（105/156）和93.59%（146/156）。MR-Late对肝转移瘤的总体检出率明显高于T2WI/FS（P=0.020）和MR-Dyn（P〈0.001）,与DWI的差异无统计学意义（P=0.064）。对≤0.5cm肝转移瘤,T2WI/FS、DWI、MR-Dyn和MR-Late的检出率分别为30.00%（6/20）、65.00%、（13/20）25.00%（5/20）和85.00%（17/20）,MR-Late检出率明显高于T2WI/FS（P=0.013）和MR-Dyn（P〈0.001）,与DWI的差异无统计学意义（P=0.219）。对0.6-1.0cm肝转移瘤,T2WI/FS,DWI和MR-Late检出率分别为88.46%（46/52）、88.46%（46/52）和86.54%（45/52）,均明显高于MR-Dyn（26/52,50.00%）。而对于〉1.0cm的肝转移瘤,所有序列检出率的差异均无统计学意义（P均〉0.05）。结论 Gd-EOB-DTPA增强扫描对结直肠癌肝转移的检出率高,尤其有助于提高≤0.5cm的肝转移瘤病灶检出率。Objective To compare the efficacy of T2 WI,DWI and Gd-EOB-DTPA enhanced MR imaging alone for detection of colorectal cancer liver metastases.Methods Thirty-one patients with colorectal cancer liver metastases underwent MR imaging including T2WI/FS,DWI,MR dynamic（MR-Dyn）and hepatobiliary phase（MR-Late）Gd-EOB-DTPA-enhanced images.Two readers interpreted the images together with any set alone.The slice,segment,distance from the liver edge and size of each detected lesion were recorded.Histopathology,intraoperative ultrasound and serial imaging（follow up or previous）served as the gold standard.The McNemartest was used to compare the diagnostic value between any two series.Results In thirty-one patients,156metastases（range 0.3—7.3cm,≤0.5cm,0.6—1.0cm,1.1—2.0cm and2.0cm was 20,52,50 and 34,respectively）were included.Detection rates for all lesions of T2WI/FS,DWI,MR-Dyn and MR-Late was 84.62%（132/156）,87.18%（136/156）,67.31%（105/156）and 93.59%（146/156）respectively.The total detection rate of colorectal cancer liver metastases with MR-Late was significantly higher than that of T2WI/FS（P=0.020）and MR-Dyn（P〈0.001）,but had no statistical difference compared with DWI（P=0.064）.The detection rate for≤0.5cm lesions with T2WI/FS,DWI,MR-Dyn and MR-Late was 30.00%（6/20）,65.00%（13/20）,25.00%（5/20）and 85.00%（17/20）,respectively.MR-Late was superior to T2WI/FS（P=0.013）and MR-Dyn（P〈0.001）,but no statistical difference compared with DWI（P=0.219）.The detection rate for 0.6—1.0cm lesions with T2WI/FS,DWI,MR-Dyn and MR-Late was 88.46%（46/52）,88.46%（46/52）,86.54%（45/52）,which was higher than that of MRDyn（26/52,50.00%）,respectively.There was no statistically significant difference between any two sets in the detection of lesion1.0cm.Conclusion MR-Late images has high detection rate for colorectal cancer liver metastases,which is especially useful for lesion ≤0.5cm.

关 键 词：扩散磁共振成像 结直肠肿瘤 肿瘤转移 钆塞酸二钠 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]