非动脉期高强化的肝胆期低信号肝硬化结节富血供转变危险因子  

Risk factors of hypervascular transformation of hepatobiliary phase hypointense cirrhotic nodules without arterial phase hyperenhancement

作　　者：邢飞[1] 张学琴[1] 缪小芬[1] 张涛[1] 邢伟[2] XING Fei;ZHANG Xueqin;MIAO Xiaofen;ZHANG Tao;XING Wei(Department of Image,Affiliated Nantong Hospital 3 of Nantong University,Nantong 226006,China;Department of Image,the Third Affiliated Hospital of Soochow University,Changzhou 213003,China)

机构地区：[1]南通大学附属南通第三医院影像科,江苏南通226006 [2]苏州大学附属第三医院影像科,江苏常州213003

出　　处：《中国医学影像技术》2022年第2期226-231,共6页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察钆塞酸二钠(Gd-EOB-DTPA)增强MRI示非动脉期高强化(APHE)的肝胆期(HBP)低信号肝硬化结节发生富血供转变的危险因子。方法回顾性分析64例接受2次及以上Gd-EOB-DTPA增强MR扫描的慢性乙型肝炎、肝硬化患者,首诊MRI检出83个非APHE的HBP低信号结节;根据随访期间增强MRI所示动脉期(AP)结节有无高强化,将其分为富血供转变组(n=25)及非富血供转变组(n=58);对比2组患者临床资料及结节MRI征象,绘制Kaplan-Meier曲线分析结节富血供转变的发生率,采用Cox回归分析观察结节富血供转变的危险因子。结果随访期间富血供转变组88.00%(22/25)结节增大,其中54.54%(12/22)DWI或T2WI呈高信号;非富血供转变组55.17%(32/58)结节增大,其中15.63%(5/32)DWI或T2WI呈高信号。2组患者病史[罹患肝细胞癌(HCC)与否]、DWI或T2WI结节是否呈高信号及结节增长率均存在显著差异(P均<0.05)。以0.60×10^(-3)/天为结节增长率的最佳截断值,其预测结节发生富血供转变的敏感度为72.00%,特异度为87.93%,曲线下面积(AUC)为0.83(95%CI 0.73~0.90,P<0.01)。Cox回归分析结果显示,DWI或T2WI呈高信号及增长率≥0.60×10^(-3)/天为结节发生富血供转变的危险因子。结论Gd-EOB-DTPA增强MRI表现为非APHE的HBP低信号肝硬化结节于DWI或T2WI呈高信号及增长率≥0.60×10^(-3)/天为其发生富血供转变的危险因子。Objective To explore the risk factors of hypervascular transformation of hepatobiliary phase(HBP)hypointense cirrhotic nodules without arterial phase hyperenhancement(APHE)on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI.Methods Data of 64 with chronic hepatitis B patients combined with liver cirrhosis who underwent Gd-EOB-DTPA enhanced MR scanning twice or more were retrospectively analyzed,and HBP hypointense nodules without APHE were detected with initial MRI.The nodules were divided into hypervascular transformation group(n=25)and non hypervascular transformation group(n=58)according to with or without high enhancement in arterial phase(AP)on enhanced MRI during follow-up period.Clinical data of patients and MRI signs of nodules were compared between groups.Kaplan-Meier curve was used to analyze the incidence of hypervascular transformation of nodules.The risk factors of hypervascular transformation were explored with Cox regression analysis.Results During follow-up period,in hypervascular transformation group,88.00%(22/25)nodules enlarged,among which 54.54%(12/22)showed hyperintensity on DWI or T2WI,while in non hypervascular transformation group,55.17%(32/58)nodules enlarged,among which 15.63%(5/32)showed hyperintensity on DWI or T2WI.There were significant differences of history of hepatocellular carcinoma(HCC),nodule with or without hyperintensity on DWI or T2WI and the growth rate of nodules between groups(all P<0.05).Taken 0.60×10^(-3)/day as the best cut-off value of nodule growth rate for predicting hypervascular transformation,the sensitivity was 72.00%,specificity was 87.93%,and the area under the curve(AUC)was 0.83(95%CI 0.73-0.90,P<0.01).Cox regression analysis showed that hyperintensity on DWI or T2WI and growth rate≥0.60×10^(-3)/day were risk factors of hypervascular transformation of nodules.Conclusion Hyperintensity on DWI or T2WI and growth rate≥0.60×10^(-3)/day of HBP hypointense cirrhotic nodules without APHE on Gd-EOB-DTPA enhanced MRI were ris

关 键 词：肝肿瘤 肝硬化 肝炎 乙型 慢性 磁共振成像 对比剂 

分 类 号：R657.3[医药卫生—外科学] R445.2[医药卫生—临床医学]