肝硬化背景下肝细胞癌Gd-DTPA和Gd-EOB-DTPA表现:基于LI-RADS(2014版)分类标准的对照研究  

Liver Imaging Reporting and Data System v2014 Categorization of Hepatocellular Carcinoma in Cirrhosis on Gd-DTPA: Comparison with Gd-EOB-DTPA

作　　者：邢飞[1] 陆健 张涛[1] 缪小芬[1] 张学琴[1] 姜吉锋[1] XING Fei;LU Jian;ZHANG Tao(Department of Radiology,Third Hospital Affiliated of Nantong University,Nantong,Jiangsu Province 226006,P.R.China)

机构地区：[1]江苏省南通市第三人民医院影像科

出　　处：《临床放射学杂志》2019年第10期1857-1861,共5页Journal of Clinical Radiology

基　　金：南通市市级科技计划项目(编号:MS22015073);南通市卫生局青年基金项目(编号:WQ2016014)

摘　　要：目的基于肝脏影像报告和数据系统(LI-RADS)2014版评分系统,探讨马根维显MRI(Gd-DTPA-MRI)与钆塞酸二钠MRI(Gd-EOB-MRI)对肝硬化背景肝细胞癌(HCC)分类诊断中的个体内对照研究。方法搜集70例(81个HCC病灶)经病理证实的慢性肝硬化患者入组本研究,均行Gd-DTPA和Gd-EOB-DTPA检查(两项检查间隔时间<1个月)。由两位高年资放射科医师对HCC主要征象共同分析,参照LI-RADS分类标准,对Gd-DTPA-MRI和Gd-EOB-MRI分别进行评分;调整LI-RADS-EOB分类标准(增加肝胆期低信号为主要征象,LI-RADS-EOBa1;肝胆期低信号环视为包膜,LI-RADS-EOBa2;过渡期低信号视为廓清,LI-RADS-EOBa3),并重新进行评分。采用配对卡方McNemar检验对Gd-DTPA-MRI、Gd-EOB-MRI及调整后的HCC主要征象识别率和对Gd-DTPA-MRI、Gd-EOB-MRI及调整后的评分为LR-5的敏感性比较。结果 Gd-EOB-MRI对廓清征象(P=0.012)和包膜征象(P=0.036)的显示率较低。在诊断LR-5敏感性上,LI-RADS-DTPA高于LI-RADS-EOB(P=0.013)和LI-RADS-EOBa2(P=0.037),低于LI-RADS-EOBa1(P=0.005),而与LI-RADS-EOBa3(P=1)相当。结论调整后的LI-RADS-EOB,如增加肝胆期低信号(主要征象)或过渡期低信号(视为廓清)能有效提高HCC诊断敏感性。Objective To use Liver Imaging Reporting and Data System(LI-RADS) categorization of HCC to compare Gd-DTPA-MRI and Gd-EOB-MRI. Methods Data from 70 patients with 81 HCCs of cirrhosis confirmed by pathology who underwent Gd-EOB-MRI and Gd-DTPA-MRI from February 2014 to June 2018, was analysed. Gd-DTPA-MRI and Gd-EOB-MRI were evaluated for the presence of major features by two radiologists. LI-RADS categorization was done for Gd-DTPA-MRI and for Gd-EOB-MRI before and after applying adjusted major features(hepatobiliary phase hypointensity as an additional major feature,LI-RADS-EOBa1;HBP hypointense rim as capsule appearance,LI-RADS-EOBa2;and transitional phase hypointensity as washout appearance,LI-RADS-EOBa3). Frequencies of major HCC features and sensitivities of LR-5 categorization for the diagnosis of HCC were compared between Gd-DTPA-MRI,Gd-EOB-MRI and then adjusted using the McNemar test. Results Washout(P=0.012) and capsule appearance(P=0.036) were less frequently observed on Gd-EOB-MRI. Sensitivity for LR-5 categorization was significantly higher with LI-RADS-DTPA compared with LI-RADS-EOB(P=0.013) and LI-RADSEOBa2(P=0.037),while sensitivity for LR-5 categorization with LI-RADS-EOBa1 was less(P=0.005) and LI-RADS-EOBa3(P=1)was comparable. Conclusion Modifying LI-RADS for use with Gd-EOB-MRI,such as applying HBP hypointensity as an additional major feature or using TP hypointensity as washout appearance,can improve the sensitivity for the detection of HCC.

关 键 词：肝细胞癌 肝硬化 肝脏影像报告及数据系统 钆塞酸二钠 

分 类 号：R73[医药卫生—肿瘤]