钆塞酸二钠MRI对肝细胞癌的诊断价值  

Value of Gd-EOB-DTPA-enhanced MRI in diagnosis of hepatocellular carcinoma

作　　者：孙玉[1] 张楠[1] 侯洁[1] 马向宏 王薇[1] 杨本强[1] 

机构地区：[1]沈阳军区总医院放射科,沈阳110001

出　　处：《临床肝胆病杂志》2018年第1期129-132,共4页Journal of Clinical Hepatology

摘　　要：目的探讨钆塞酸二钠(Gd-EOB-DTPA)MRI诊断肝细胞癌(HCC)的临床价值。方法选择2016年10月-2017年4月于沈阳军区总医院就诊的40例肝硬化或疑似HCC患者,收集患者的Gd-EOB-DTPA增强MRI动态三期(动脉期、门静脉期、延迟期)及肝胆期(延迟20 min)和弥散加权成像(DWI)(b=50、400、1000 s/mm2)资料。2位医师协商一致根据有、无肝胆期图像分别作出诊断及信心评分。以术后病理或临床诊断为标准评价HCC诊断准确率。计量资料采用t检验分析,计数资料采用χ~2检验。结果 40例患者共检出42个HCC病灶和37个肝硬化结节。HCC和肝硬化结节在肝胆期和DWI序列中信号强度差异有统计学意义(χ~2值分别为64.503、67.855,P值均<0.001)。HCC和肝硬化结节在b=400 s/mm2和b=1000 s/mm2DWI序列时的表观扩散系数比较差异均有统计学意义(t值分别为62.75、75.36,P值均<0.001)。诊断医师通过Gd-EOB-DTPA增强动态三期以及动态四期(含肝胆期)两组图像的诊断信心评分依次为(3.260±0.521)分和(4.620±0.661)分,差异有统计学意义(t=10.67,P<0.001)。以病理和临床诊断为标准,诊断医师通过Gd-EOB-DTPA增强动态三期、动态四期(含肝胆期)两组图像,对HCC的诊断准确率分别为76.19%(32/42)、95.24%(40/42),差异有统计学意义(χ~2=6.222,P=0.013)。结论 Gd-EOB-DTPA MRI可提高医师对HCC的诊断准确率与信心,具有重要的临床应用价值。Objective To investigate the value of Gd-EOB-DTPA-enhanced MRI in the diagnosis of hepatocellular carcinoma(HCC).Methods A total of 40 patients with liver cirrhosis or suspected HCC who visited General Hospital of Shenyang Military Area Command from October 2016 to April 2017 were enrolled,and the data on three dynamic phases of Gd-EOB-DTPA-enhanced MRI(arterial phase,portal venous phase,and delayed phase),hepatobiliary phase(delayed for 20 minutes),and diffusion-weighted imaging(DWI)(b=50,400,and 1000 s/mm^2)were collected.Two radiologists made a diagnosis and gave diagnostic confidence scores based on the presence or absence of hepatobiliary phase images.Postoperative pathology or clinical diagnosis was used as the criteria for assessing the diagnostic accuracy of HCC.The t-test was used for comparison of continuous data,and the chi-square test was used for comparison of categorical data.Results A total of 42 HCC lesions and 37 cirrhotic nodules were detected.There were significant differences between HCC lesions and cirrhotic nodules in signal intensity on hepatobiliary phase and DWI(χ^2=64.503 and 67.855,both P<0.001),as well as the apparent diffusion coefficient when the b-values of DWI were 400 s/mm^2 and 1000 s/mm^2(t=62.75 and 75.36,both P<0.001).There was a significant difference in diagnostic confidence score given by the radiologists between the images of three dynamic phases of Gd-EOB-DTPA-enhanced MRI and those of four dynamic phases(including hepatobiliary phase)(3.260±0.521 vs 4.620±0.661,t=10.67,P<0.001).With postoperative pathology and clinical diagnosis as criteria,the images of three dynamic phases of Gd-EOB-DTPA-enhanced MRI had a significantly higher diagnostic accuracy for HCC than those of four dynamic phases(including hepatobiliary phase)[76.19%(32/42)vs 95.24%(40/42),χ^2=6.222,P=0.013].Conclusion Gd-EOB-DTPA-enhanced MRI may improve diagnostic accuracy and confidence for HCC and has an important clinical value.

关 键 词：癌 肝细胞 磁共振成像 弥散 钆塞酸二钠 

分 类 号：R735.7[医药卫生—肿瘤]