普美显和马根维显MRI增强对肝硬化背景下小肝癌诊断的对比研究  

Diagnostic Performance of Gd-DTPA and Gd-EOB-DTPA MRI for Small Hepatocellular Carcinomas in Cirrhosis

作　　者：赵锦洪 彭德新[2] 杨智利[3] 徐仁根[2] 刘岚[2] 龚良庚[1] ZHAO Jinhong;PENG Dexin;YANG Zhili(Department of radiology,The Second Affiliated Hospital of Nanchang University,Nanchang 330006,P.R.China;Department of radiology,Jiangxi Cancer Hospital,Nanchang 330029,P.R.China;Department of Ultrasound,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,P.R.China)

机构地区：[1]南昌大学第二附属医院影像中心,南昌330006 [2]江西省肿瘤医院放射科,南昌330029 [3]江西省妇幼保健院超声科,南昌330006

出　　处：《江西医药》2021年第7期915-918,共4页Jiangxi Medical Journal

基　　金：江西省卫生计生委普通科技计划项目,编号20195444。

摘　　要：目的比较普美显与马根维显磁共振动态增强扫描对肝硬化背景下小肝癌的诊断价值。方法收集70例肝硬化患者共76枚小肝癌(≤3cm),所有患者均行常规上腹部MRI平扫、马根维显及普美显MRI动态增强扫描。由两位阅片者采用双盲法独立阅片,记录病灶的大小、平扫信号特点、强化方式及阅片者诊断肝癌的信心评分,比较两种增强方式下肝癌病灶的检出率、诊断肝癌信心分值、一致性、ROC曲线下的面积、灵敏度、阳性预测值。结果⑴对于≤1cm的肝癌,普美显对肝癌检出率明显高于马根维显(P<0.05);而对于1cm<肝癌≤3cm,普美显与马根维显检出率无差别(P>0.05)。⑵两名阅片者在普美显成像下诊断信心分值均有提高(P<0.05);两名阅片者在普美显成像下对肝癌的一致性均增加。⑶普美显成像下诊断肝癌的敏感度较马根维显有提高(P<0.05)。(4)普美显、马根维显诊断肝癌的ROC曲线下面积均较有提高,差异均无统计学意义(P>0.05)。结论普美显磁共振动态增强扫描有助于提高阅片者对肝硬化背景肝癌的诊断信心,尤其有助于≤1cm小肝癌的检出,从而提高诊断能力。Objective To evaluate the diagnostic value of Gd-DTPA and Gd-EOB-DTPA MRI for small hepatocellular carcinoma(sHCC)in cirrhosis.Methods A total of 70 cirrhotic patients with 76 sHCC lesions underwent two MRI examinantions(The first group was epigastric MRI plain scan and Gd-DTPA enhanced MRI scan;the second group was epigastric MRI plain scan and Gd-EOB-DTPA enhanced MRI scan).Two separate blind image analyses of the two imaging sets were performed.The size of the lesions,signal characteristics of the lesions,the enhancement styles,and the confidence scores were recorded.The detection rate of HCC,the confidence scores for HCC diagnosis,consistency,area under the receiver operating characteristic(ROC)curve,sensitivity and positive predictive values were compared.Results(1)The detection rate of sHCC(the sHCC lesion≤1cm)in the second group was higher than that of the first one by both observers and the differences were statistically significant(P<0.05),while no significant differences were detected for another(1cm<the sHCC lesion≤3cm)(P>0.05).(2)The confidence scores of the observers in the second group were higher than those of the first one by both observers were statistically significant(P<0.05).The consistency of the both observers increased.(3)There was a significant increase in the diagnostic sensitivity and positive predictive values of the both observers in the second group(P<0.05).The sensitivity increased significantly(P<0.05)and no significant differences were detected for the positive predictive values by both observers(P>0.05).(4)The area under the ROC curve improved by both observers in the second group,and no significant differences were detected(P>0.05).Conclusion Gd-EOB-DTPA MRI is helpful to improve the diagnostic efficacy of HCC in cirrhosis by increasing observer’s confidence,especially in the detection of sHCC(the sHCC lesion≤1cm).

关 键 词：普美显 马根维显 磁共振成像 肝硬化 小肝癌 

分 类 号：R735.7[医药卫生—肿瘤]