钆贝葡胺双功能对比一站式MRI成像对肝细胞癌的诊断价值分析  

Diagnostic Value of Gd-BOPTA Dual-functional Contrast Enhanced One-step MRI Imaging for Hepatocellular Carcinoma

作　　者：李丽艳[1] 褚丽娟 赵伟[2] 郭云志[1] 申国强 王晓燕[3] 周顺科[4] LI Li-yan;CHU Li-juan;ZHAO Wei;GUO Yun-zhi;SHEN Guo-qiang;WANG Xiao-yan;ZHOU Shun-ke(Department of Radiology,Jilin City People's Hospital,Jilin 132001,China;Department of Laboratory,Jilin City People's Hospital,Jilin 132001,China;Department of Gastroenterology,Jilin City People's Hospital,Jilin 132001,China;Department of Radiology,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]吉林省吉林市人民医院放射科,132001 [2]吉林省吉林市人民医院检验科,132001 [3]吉林省吉林市人民医院消化内科,132001 [4]中南大学湘雅二医院放射科,湖南省长沙市410011

出　　处：《中国全科医学》2018年第9期1124-1129,共6页Chinese General Practice

基　　金：吉林省卫生厅基金课题项目(2013Z064)

摘　　要：目的基于2014年版肝脏影像报告和数据系统(LI-RADS),探讨钆贝葡胺(Gd-BOPTA)双功能对比一站式MRI成像(DFCE-MRI)对肝细胞癌(HCC)的诊断价值。方法选择2013年10月—2016年9月吉林市人民医院收治的68例临床确诊的肝硬化并肝局灶性病变(FLL)患者,依次行(1)平扫,(2)弥散加权成像(DWI),(3)Gd-BOPTA多期增强,(4)Gd-BOPTA肝胆期扫描的肝脏MRI检查[(1)+(2)+(3)+(4)简称DFCE-MRI,(1)+(2)+(3)简称多模态MRI,(3)简称多期增强MRI]。采用2014年版LI-RADS分类标准对FLL进行诊断,并与病理检查结果进行比较。结果 68例肝硬化患者MRI共发现71枚FLL,其中LR-1类病灶和LR-2类病灶共计15枚,病理检查结果均为良性;LR-3类病灶3枚,2枚为HCC;LR-4类病灶12枚,11枚为HCC;29枚LR-5类病灶均为HCC。若将LR-1~LR-3类病灶归为阴性,LR-4~LR-5类病灶归为阳性,则基于DFCE-MRI、多模态MRI、多期增强MRI的LI-RADS分类诊断HCC的受试者工作曲线下面积(AUC)分别为0.947、0.894、0.852;其中AUCDFCE-MRI大于AUC多期增强MRI(Z=2.110,P<0.05),AUCDFCE-MRI与AUC多模态MRI比较(Z=1.079,P>0.05)、AUC多模态MRI与AUC多期增强MRI比较(Z=0.753,P>0.05),差异均无统计学意义。结论基于2014年版LI-RADS分类标准,采用Gd-BOPTA肝脏DFCE-MRI对HCC有很好的诊断价值,有利于提高MRI诊断效能。Objective To explore the value of gadobenate dimeglumine(Gd-BOPTA)-based dualfunctional contrast enhanced one-step MRI(DFCE-MRI)in diagnosing hepatocellular carcinoma(HCC)assessed by the Liver Imaging Reporting and Data Management System(LI-RADS,2014 version).Methods A total of 68 patients who were definitively diagnosed with cirrhosis accompanied by focal liver lesions(FLL)in Jilin City People's Hospital between October 2013 and September 2016 were included in this study.The patients were given MRI scans in the following order:(1)plain scan;(2)diffusion-weighted imaging(DWI);(3)Gd-BOPTA multi-phase enhancement;(4)Gd-BOPTA hepatobiliary phase scan〔(1)+(2)+(3)+(4)was abbreviated as DFCE-MRI,(1)+(2)+(3)was abbreviated as multimodal MRI,and(3)was abbreviated as MCE-MRI〕.FLL were diagnosed based on the 2014 LI-RADS criteria and in comparison with the gold standard of pathological examination.Results In 68 cirrhosis patients,MRI identified 71 FLLs including 15 LR-1 and LR-2 lesions which were confirmed benign by pathology,three LR-3 lesions of which two were HCC,12 LR-4 lesions of which 11 were HCC,and 29 LR-5 lesions which were all HCC.If the LR-1-LR-3 lesions were classified as negative,the AUCs of DFCE-MRI,multimodal MRI,and MCE-MRI based on LIRADS criteria were 0.947,0.894 and 0.852,respectively.The AUC of DFCE-MRI was significantly higher than that of MCE-MRI(Z=2.110,P<0.05).There was no significant difference in the AUC for DFCE-MRI vs.multimodal MRI(Z=1.079,P>0.05),or multimodal MRI vs.MCE-MRI(Z=0.753,P>0.05).Conclusion Gd-BOPTA based liver DFCE-MRI has high clinical value in diagnosing HCC according to the 2014 LI-RADS classification criteria.The technique can improve the diagnostic effectiveness of MRI.

关 键 词：磁共振成像 钆贝葡胺 癌 肝细胞 肝脏影像报告及数据系统 

分 类 号：R730.261[医药卫生—肿瘤]