多期动态增强CT与MRI对小肝癌诊断的比较分析研究  

The comparative study of multiphasic dynamic contrast-enhanced CT and MRI in diagnosis of small hepatocellular carcinoma

作　　者：陈枫[1] 李宏军[1] 李雪芹[1] 贾翠宇[1] 赵大伟[1] 

机构地区：[1]首都医科大学附属北京佑安医院放射科,北京100069

出　　处：《医学影像学杂志》2016年第9期1634-1638,共5页Journal of Medical Imaging

基　　金：北京市医药管理临床医学发展专项经费资助(编号:ZYLX201511)

摘　　要：目的评估慢性肝病合并小肝癌患者在多期动态增强CT及MRI扫描中强化程度的差异以及MRI双动脉期扫描的必要性。方法观察137例经病理证实的直径小于20mm的小肝癌病例。所有病例均行多期动态增强CT及MRI检查。比较病灶在CT及MRI动脉期强化程度和平衡期对比剂流出程度的差异,以及病灶在MRI动脉早期与动脉晚期强化程度的差异。相对于正常肝实质密度或信号,动脉期病灶明显强化评为1分,轻度强化为2分,无强化为3分;平衡期病灶密度或信号无减低(即无对比剂流出效应)为4分,轻度减低为5分,明显减低为6分。结果增强MRI动脉期小肝癌强化程度高于CT动脉期,CT平衡期小肝癌的对比剂流出效应优于MRI平衡期,组间比较差异均有统计学意义(P<0.05)。在增强MRI双动脉期扫描中,动脉晚期小肝癌强化程度高于动脉早期,差异有统计学意义(P<0.05)。近半数小肝癌(65/137,47.45%)在MRI平衡期出现边缘环状强化,明显高于CT平衡期(4/137,2.92%),差异有统计学意义(2=72.079,P<0.05)。结论小肝癌在增强MRI动脉期强化效果优于CT,在MRI平衡期对比剂流出效应弱于CT,但MRI平衡期病灶的边缘环状强化可以辅助诊断。MRI双动脉期扫描,尤其是动脉晚期有助于提高小肝癌的检出。Objective To evaluate the dynamic patterns of small hepatocellular carcinomas on multiphasic contrast-enhanced CT compared with MRI in patients with chronic liver disease and the necessity of dual-arterial phase on MRI. Methods One hundred and thirty-seven patients with small HCCs （ 〈 20 mm in diameter） proved by pathologic examination were observed. All of the cases underwent multiphasie contrast-enhanced CT and MRI examination. The degree of enhancement on arterial-phase and washout effects on equilibrium-phase CT and MRI imaging were analyzed. Compared with the surrounding liver parenchyma, the contrast enhancement patterns of each lesion on arterial and equilibrium phases were categorized as one of six grades ： 1 = obvious enhancement, 2 = slightly enhancement, 3 -- no enhancement, 4 = no washout effect, 5 = slightly washout effect, 6 -- obvi- ous washout effect. Results Small HCCs showed higher degree of enhancement on arterial-phase MRI than that of CT, but it in- dicated better washout effects on equilibrium-phase CT than that of MRI, which had differences among the groups （ P 〈 0.05 ）. During dual-arterial MRI dynamic imaging, small HCCs showed higher degree of enhancement on early arterial-phase than late ar- terial-phase, which had statistical significance （ P 〈 0.05 ）. Almost half of the cases （65/137, 47.45 % ） showed enhancing rim at the margin of the tumor on equilibrium-phase MRI, significantly higher than that of CT, which had statistical significance （ X2 = 72. 079, P 〈 0. 05 ）. Conclusion The enhancement effects for small HCCs on arterial-phase MRI were superior to those of on CT, but the washout effects for lesions on equilibrium-phase MRI imaging were inferior to those of on CT. Furthermore, the rim enhancement for small HCCs on equilibrium-phase MRI can assist diagnosis. Dual arterial phase scanning on MRI, especially late arterial-phase, can improve detection rate of small HCCs.

关 键 词：肝细胞癌 体层摄影术 X线计算机 磁共振成像 

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