钆塞酸二钠对肝硬化背景下小肝癌的诊断价值分析  

The value of Gd-EOB-DTPA in the diagnosis of small hepatocellular carcinoma in patients with liver cirrhosis

作　　者：吴英宁[1] 黄莉娜 马德智[1] 李保生[1] 吴为民[1] 梁伟[1] Wu Yingning;Huang Lina;Ma Dezhi;Li Baosheng;Wu Weimin;Liang Wei(Department of Radiology,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise,533000,China)

机构地区：[1]右江民族医学院附属医院放射科,广西百色533000

出　　处：《右江民族医学院学报》2020年第2期184-186,215,共4页Journal of Youjiang Medical University for Nationalities

基　　金：广西卫生计生委自筹经费课题(Z2016415)。

摘　　要：目的探讨钆塞酸二钠MRI动态增强三期(动脉期、门静脉期、平衡期)及肝胆特异期对肝硬化背景下小肝癌的诊断价值。方法回顾性分析经手术病理证实的肝硬化合并小肝癌患者共53例,将平扫图像、动态增强三期图像定为A组,A组图像加上肝胆特异期图像定为B组。将A组及B组影像诊断分别与病理结果对照。结果53例患者均有肝硬化表现,在T 2WI上呈网格状改变,共发现了60个结节。根据动脉期结节明显强化,门静脉期结节强化减退,平衡期结节呈低信号,共有53个结节被诊断为小肝癌;另有7个结节,动脉期强化不明显,门静脉期轻度强化,平衡期呈等或低信号,被诊断为肝硬化结节。肝胆特异期上述60个结节未见造影剂摄取呈低信号,结合平扫及动态增强三期特点,60个结节均诊断为小肝癌。平扫及动态增强三期扫描对小肝癌的诊断符合率为88.33%,而结合肝胆特异期扫描诊断符合率达100%,两者之间的差异有统计学意义(P<0.05)。结论钆塞酸二钠动态增强三期结合肝胆特异期扫描能明显提高肝硬化背景下小肝癌的诊断符合率。Objective To explore the value of three dynamic phases of Gd-EOB-DTPA-enhanced MRI(arterial phase,portal venous phase,equilibrium phase)and hepatobiliary specific phase in the diagnosis of small hepatocellular carcinoma(sHCC)in patients with liver cirrhosis.Methods Fifty-three patients with liver cirrhosis complicated with sHCC confirmed by surgical pathology were retrospectively analyzed.The images of MRI plain scan and three-phase dynamic enhanced scan were classified as group A,and the images of group A combined with the images of hepatobiliary specific phase were classified as group B.Results of imaging diagnosis of group A and group B were compared with pathological results respectively.Results All the 53 patients presented with features of liver cirrhosis,showing grid-shaped changes on T 2WI,and a total of 60 nodules were found.A total of 53 nodules were diagnosed as sHCC according to the obvious enhancement in the arterial phase,decreased enhancement in the portal venous phase,and low signal in the equilibrium phase.Another 7 nodules were diagnosed as cirrhotic nodules,with no obvious enhancement in the arterial phase,slight enhancement in the portal venous stage,equal or low signal in the equilibrium phase.No low signal of contrast agent uptake was observed in the above 60 nodules at the hepatobiliary specific phase,and combined with the characteristics of plain scan and three-phase dynamic enhanced scan,all 60 nodules were diagnosed as sHCC.The coincidence rate of plain scan combined with three-phase dynamic enhanced scan in the diagnosis of sHCC was 88.33%,while the coincidence rate of plain scan and three-phase dynamic enhanced scan combined with hepatobiliary specific phase scan reached 100%,the difference between the two groups was statistically significant(P<0.05).Conclusion Three dynamic phases of Gd-EOB-DTPA-enhanced MRI combined with hepatobiliary specific phase scan can improve significantly the diagnostic coincidence rate of sHCC in patients with cirrhosis.

关 键 词：钆塞酸二钠 磁共振成像 肝硬化 癌 肝细胞 

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