钆塞酸二钠增强磁共振和弥散加权成像诊断肝细胞癌TACE术后存活或复发病灶的价值  

Diagnostic value of Gd-EOB-DTPA enhanced MRI and DWI in residual or recurrent lesions after TACE for hepatocellular carcinoma

作　　者：刘海峰[1] 许永生[1] 刘钊[1] 卢星如[1] 雷军强[1] LIU Haifeng;XU Yongsheng;LIU Zhao;LU Xingru;LEI Junqiang(Department of Radiology,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院放射科,甘肃兰州730000

出　　处：《中国医学物理学杂志》2020年第5期561-567,共7页Chinese Journal of Medical Physics

基　　金：国家自然科学基金(81960323);兰州大学中央高校基本科研业务(lzujbky-2019-cd04);甘肃省自然科学基金(1506RJZA265)。

摘　　要：目的:探究钆塞酸二钠(Gd-EOB-DTPA)增强磁共振(MRI)和弥散加权成像(DWI)诊断肝细胞癌(HCC)经导管肝动脉化疗栓塞(TACE)术后存活或复发病灶的价值。方法:前瞻性连续纳入初次接受TACE治疗的96例患者的129个HCC病灶。以CT和/或MRI随访,手术病理为诊断金标准,探究Gd-EOB-DTPA增强MRI和DWI对TACE术后1~2月HCC病灶存活或复发的诊断准确性,并采用ROC曲线分析ADC值对存活或复发病灶的鉴别诊断价值。运用卡方检验分析T1WI信号、T2WI信号、形态、包膜、DWI信号、动脉期增强表现及肝特异期信号判断TACE术后存活或复发的价值。结果:(1)金标准证实TACE术后存活病灶29个,肝内复发病灶18个,完全坏死病灶82个;(2)TACE术后HCC存活或复发病灶多呈现出T1WI低信号、T2WI高信号、DWI高信号的表现,89.36%(42/47)病灶动脉期强化,91.49%(43/47)肝细胞期未见造影剂摄取呈低信号;(3)Gd-EOB-DTPA增强MRI和DWI诊断TACE术后存活或复发病灶的敏感度、特异度分别为93.62%和91.49%、96.34%和95.12%,两者联合诊断的敏感度和特异度为95.74%、100.00%;(4)病灶无包膜、DWI高信号、动脉期增强是判断TACE术后存活或复发的独立重要因素(P<0.05)。结论:Gd-EOB-DTPA增强MRI和DWI对TACE术后HCC存活或复发病灶具有较高的诊断价值,可应用于TACE术后临床随访。Objective To investigate the value of Gd-EOB-DTPA enhanced magnetic resonance imaging(MRI)and diffusion weighted imaging(DWI)in the diagnosis of residual or recurrent lesions after transarterial chemoembolization(TACE)for hepatocellular carcinoma(HCC).Methods A prospective and consecutive study was performed on 96 patients with 129 HCC lesions who had undergone TACE.The follow-up results by CT and/or MRI and surgery pathology were taken as the diagnostic gold standard,and the diagnostic accuracy of Gd-EOB-DTPA enhanced MRI and DWI in detecting residual or recurrent lesions at 1-2 months after TACE for HCC was investigated.Meanwhile,receiver operating characteristics(ROC)curve was used to evaluate the value of apparent diffusion coefficient(ADC)in the differential diagnosis of residual or recurrent lesions.Moreover,the diagnostic value of imaging signs in residual or recurrent lesions after TACE was explored by Chi-square test.The discussed imaging signs included T1 WI signal,T2 WI signal,morphology,capsule,DWI signal,arterial-phase enhancement performance and liver-specific phase signal.Results The evaluation by gold standard confirmed that there were 29 residual lesions,18 hepatic recurrent lesions and 82 necrotic lesions after TACE.The residual or recurrent lesions after TACE were characterized with hypointense on T1 WI,hyperintense on T2 WI and hyperintense on DWI.The residual or recurrent lesions with enhancement in arterial phase accounted for 89.36%(42/47)and those without hypointense of contrast agent uptake in hepatocellular phase accounted for 91.49%(43/47).The sensitivity and specificity of Gd-EOB-DTPA enhanced MRI in the diagnosis of residual or recurrent lesions after TACE were 93.62%and 96.34%,respectively,and those of DWI were 91.49%and 95.12%,respectively.The sensitivity and specificity of the combination reached 95.74%and 100.00%.No capsule,hyperintense on DWI and the enhancement of arterial-phase signal were important independent factors in diagnosing residual or recurrent lesions after TACE(P<0.

关 键 词：钆塞酸二钠 弥散加权成像 肝细胞癌 经导管肝动脉化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤] R816[医药卫生—临床医学]