钆塞酸二钠增强MRI T1mapping鉴别诊断不典型增生结节及不同分化程度肝细胞癌的价值  

The value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced T1 mapping in dysplastic nodule and hepatocellular carcinoma with different degrees of differentiation

作　　者：覃夏丽 黄仲奎[1] 龙莉玲[1] 高银娟 李文美[1] 周智鹏[2] Qin Xiali;Huang Zhongkui;Long Liling;Gao Yinjuan;Li Wenmei;Zhou Zhipeng(Department of Radiology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院放射科,南宁530021 [2]桂林医学院附属医院放射科

出　　处：《中华放射学杂志》2018年第8期603-607,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金（81260214）

摘　　要：目的 探讨钆塞酸二钠（Gd-EOB-DTPA）增强MRI T1 mapping鉴别诊断不典型增生结节（DN）及不同分化程度肝癌（HCC）的价值.方法 回顾性分析广西医科大学第一附属医院2015年9月至2017年12月,经穿刺或手术病理证实为HCC或DN,术前或穿刺活检前进行过Gd-EOB-DTPA增强MRI T1 mapping检查的71例患者（79个病灶）.79个病灶中,DN共10个,高分化HCC 15个、中分化HCC 36个,低分化HCC 18个.患者均行肝脏MRI平扫及Gd-EOB-DTPA增强检查.在获得的T1 mapping图像上,分别测量延迟20 min肝胆期瘤灶和非瘤肝实质的T1值,计算瘤灶相对非瘤肝实质T1值增加率.采用单因素方差分析比较DN及3组不同分化程度HCC的T1值、瘤灶相对非瘤肝实质的T1值增加率的差异,采用Spearman等级相关分析评价T1 mapping参数和DN及HCC恶性程度的相关性,采用ROC评价T1 mapping参数鉴别诊断DN与不同分化程度HCC的效能.结果 DN及不同分化程度HCC的T1值和T1值增加率差异均有统计学意义（P均〈0.05）,增强后从DN到低分化HCC组,T1值和T1值增加率均呈递增趋势.T1值、T1值增加率与DN及HCC的恶性程度均呈中等正相关（r值分别为0.418和0.634,P均〈0.01）.高分化与中分化、低分化HCC间的T1值增加率差异有统计学意义（P〈0.05）.T1值和T1值增加率对于鉴别DN与高分化、中分化及低分化HCC的ROC下面积分别为0.933、0.928、0.939,0.867、0.961、0.961;T1值增加率鉴别高分化与中分化、低分化HCC的ROC下面积分别为0.770、0.844.结论 Gd-EOB-DTPA增强T1 mapping能够为鉴别DN及不同分化程度的HCC提供一些有价值诊断信息.Objective To explore the value of gadolinium-ethoxybenzyl-diethylenetriamine （Gd-EOB-DTPA） enhanced MRI T1 mapping in diagnosing and distinguishing dysplastic nodule （DN） and hepatocellular carcinoma （HCC） with different degrees of differentiation. Methods A retrospective study in the first affiliated Hospital of Guangxi Medical University from September 2015 to December 2017 was conducted. Seventy-one patients with HCC or DN （a total of 79 lesions） that confirmed by biopsy or surgical pathology findings. Seventy-nine lesions were divided into DN （n=10）, well differentiated HCC （n=15）, moderately differentiated HCC （n=36） and poorly differentiated HCC （n=18） according to histopathology. All the patients underwent plain MRI scan and Gd-EOB-DTPA-MRI T1 mapping before surgery or needle biopsy. The T1 values of each lesion and non-tumorous liver parenchyma were measured on 20 minhepatobiliary phase （HBP） T1 mapping after Gd-EOB-DTPA administration, respectively. The increment rate of T1 value in lesions relative to non-tmnorous liver parenchyma were calculated. One-way ANOVA was used to compare the differences of T1 value and the increment rate of T1 value of DN and 3 groups of HCC with different degrees of differentiation. Spearman correlation was used to evaluate the correlation between T1 mapping parameters and the malignancy degree of DN and HCC. Area under the receiver operating characteristic （ROC） curves were used to evaluate the efficacy of T1 mapping parameters in the differential diagnosis of DN and HCC with different degree of differentiation. Results Significant differences were found in T1 value and increase rate of T1 value of DN and HCC with different degrees of differentiation （P〈 0.05）. The T1 value and increase rate of T1 value showed an increasing trend from DN to poorly differentiated HCC after enhancement. The T1 value and increase rate of T1 value were positively correlated with the malignancy of DN and HCC （r=0.418 and 0.634, P〈0.01）. There we

关 键 词：肝肿瘤 磁共振成像 钆塞酸二钠 不典型增生结节 分化程度 

分 类 号：R445.2[医药卫生—影像医学与核医学]