Gd-EOB-DTPA对肝硬化背景下LI-RADS 3类病变(﹤2 cm)的诊断及随访观察价值  

Diagnosis and Follow-up of Gd-EOB-DTPA for LI-RADS Category 3 Nodules within 2 cm

作　　者：吴斐斐 张学琴[1] 缪小芬[1] 张涛[1] 邢飞[1] WU Feifei;ZHANG Xueqin;MIAO Xiaofen(Department of Radiology,The Third Hospital Affiliated of Nantong University,Nantong,Jiangsu Province 226006,P.R.China)

机构地区：[1]南通大学附属南通第三医院影像科,226000

出　　处：《临床放射学杂志》2022年第6期1055-1059,共5页Journal of Clinical Radiology

摘　　要：目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI对肝脏影像报告和数据系统(LI-RADS,简称LR)3类(﹤2 cm)病变的诊断及随访观察价值。方法搜集首诊、随访均行Gd-EOB-DTPA检查,基线病灶LR-3类(﹤2 cm)患者作为研究对象,根据有/无动脉期高强化(APHE)分为两组(A组为APHE;B组为无APHE),记录随访时间及LI-RADS分类调整情况。纳入与不纳入肝胆期(HBP)低信号对基线病变的检出率比较采用χ^(2)检验。采用Kaplan-Meier曲线分析两组病变分类上调的发生率,并采用对数秩次(Log-Rank)检验比较。结果109例患者138个基线病灶,随访时长2.8~78.5个月,中位随访时长18.0个月,其中A组占39.9%(55/138),B组占60.1%(83/138)。HBP低信号提高了基线LR-3类病变[94.9%(131/138)vs.77.5%(107/138),P<0.001]尤其B组病变[100%(83/83)vs.62.7%(52/83),P<0.001]的检出率。随访观察后,56个病灶LI-RADS分类上调至LR-4/LR-5(A组31个,B组25个),75个病灶保持不变,7个分类下调至LR-1/LR-2或消失。LR-3类病变分类上调的累积发生率为40.6%(56/138),其中,A组LR分类上调的发生率高于B组[56.4%vs.30.1%,Log-rank检验P<0.0001;风险比(HR)=2.86(95%CI:1.62~5.10)],中位随访时长短于B组[7.0个月(3.8,15.9)个月vs.15.5个月(11.7,27.2)个月,P=0.002],其中3、6、12、24个月上调发生率,A组分别为7.3%、21.8%、36.4%、55.6%,B组分别为0%、2.4%、7.2%、27.1%。结论基于Gd-EOB-DTPA检查的LR-3类(﹤2 cm)病变分A、B两组,HBP低信号有助于提高病灶(尤其B组)的检出率及LR分级准确率。A组与B组病变呈现不同的自然转归,A组LI-RADS分类上调的累积发生率较高、中位随访时间较短。Objective To investigate the diagnostic and follow-up value of Gd-EOB-DTPA enhanced MRI in liver imaging report and data system(LI-RADS,LR)category 3 within 2 cm.Methods LR-3 observations(﹤2 cm)on initial Gd-EOB-DTPA were divided into two groups according to with/without arterial phase hyperenhancement(APHE),group A with APHE and group B with no APHE,and follow-up data on Gd-EOB-DTPA were retrospectively reviewed.Follow-up duration and category modifications were recorded for each observation.Theχ^(2) test was used to compare the detection rate of baseline observations with and without hepatobiliary phase(HBP)hypointensity.The two groups of cumulative incidence curves for progression were analyzed using Kaplan-Meier method,and compared with Log-Rank test.Results 138 LR-3 observations in 109 patients with a median follow-up of 18.0(2.8-78.5)months were included,of which 39.9%(55/138)were in group A and 60.1%(83/138)in group B.HBP hypointensity increased the detection rate of baseline LR-3 observations(94.9%vs.77.5%,P<0.01),especially in group B(100%vs.62.7%,P<0.01).The cumulative incidence of progression of LR-3 was 40.6%(56/138),with a higher incidence of progression of LR classification in group A than in group B[56.4%vs.30.1%,log-rank test P<0.0001;HR(hazard ratio)=2.86(95%CI:1.62-5.10)],with a shorter median follow-up than in group B[7.0(3.8,15.9)months vs.15.5(11.7,27.2)months,P=0.002].The cumulative incidence of upgraded in 3,6,12 and 24 months,group A were 7.3%,21.8%,36.4%and 55.6%,group B were 0%,2.4%,7.2%and 27.1%.Conclusion LR-3(<2 cm)detected by Gd-EOB-DTPA can be divided into group A and group B.HBP hypointensity helps to improve the detection rate of observations(especially in group B)and the accuracy of LR category.Compared with group B,Group A showed different natural outcome,with the relatively higher cumulative incidence and shorter median follow-up of progression.

关 键 词：肝细胞癌 钆塞酸二钠 肝脏影像报告与数据系统 随访研究 

分 类 号：R735.7[医药卫生—肿瘤] R730.44[医药卫生—临床医学]