基于Gd-EOB-DTPA增强MRI对肝硬化结节和小肝细胞癌的定量分析  

Quantitative Analysis of Cirrhosis Nodules and Small Hepatocellular Carcinoma Based on Gd-EOB-DTPA Enhanced Magnetic Resonance Imaging

作　　者：杨泽铖 曾蒙苏 单飞[1] 张澍杰 施楠楠 刘锴 YANG Zecheng;ZENG Mengsu;SHAN Fei;ZHANG Shujie;SHI Nannan;LIU Kai(Department of Radiology,Zhongshan Hospital,Fudan University&Shanghai Institute of Medical Imaging,Shanghai 200032,China;不详)

机构地区：[1]上海市(复旦大学附属)公共卫生临床中心放射科,上海201508 [2]复旦大学附属中山医院放射科&上海市影像医学研究所,上海200032

出　　处：《中国医学影像学杂志》2022年第10期1020-1024,共5页Chinese Journal of Medical Imaging

基　　金：上海申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12019128);上海市公共卫生临床中心院内课题(KY-GW-2021-11)。

摘　　要：目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI表观扩散系数(ADC)、对比增强比(CER)及T1的下降百分比(T1d%)对肝硬化结节和小肝细胞癌(sHCC)的定量评估价值与鉴别诊断效能。资料与方法回顾性收集2019年6月—2020年12月于复旦大学附属中山医院行Gd-EOB-DTPA腹部增强MRI检查,具有肝硬化背景且经病理或随访证实的30例肝硬化结节和36例sHCC的影像资料。测量两组病灶的ADC值、CER值及T1d%,并进行组间比较。采用受试者工作特征(ROC)曲线分析各定量参数对肝硬化结节和sHCC的鉴别诊断效能,Logistic回归建立3个定量参数联合诊断模型,采用Delong检验比较单一参数与联合参数诊断效能的差异。结果纳入66个病例共77个病灶,其中肝硬化结节组39个病灶,sHCC组38个病灶。肝硬化结节组的平均ADC值、CER值及T1d%分别为(1391.05±160.25)×10^(−3)mm^(2)/s、(97.47±48.37)%、(62.61±13.40)%,sHCC组的平均ADC值、CER值及T1d%分别为(1081.60±282.12)×10^(−3)mm^(2)/s、(51.10±18.98)%、(47.87±11.86)%,两组以上指标差异均有统计学意义(t=5.898、5.563、5.105,P均<0.001)。3个参数ROC曲线下面积分别为0.821、0.791、0.789,鉴别诊断的最佳阈值分别为1242.70×10^(−3)mm^(2)/s、68.83%、59.24%。联合参数的ROC曲线下面积为0.903,高于单一参数的诊断效能(P均<0.05)。结论ADC值、CER值及T1d%对鉴别肝硬化结节和sHCC均有价值,定量参数联合诊断优于单一参数。Purpose To explore the quantitative evaluation value and differential diagnosis efficacy of apparent diffusion coefficient(ADC),contrast enhancement ratio(CER)and T1 value decrease percentage(T1d%)of Gd-EOB-DTPA enhanced MRI for cirrhotic nodules and small hepatocellular carcinoma(sHCC).Materials and Methods The Gd-EOB-DTPA enhanced MR images of patients with liver cirrhosis in Zhongshan Hospital of Fudan University from June 2019 to December 2020 were retrospectively collected.Finally,30 patients with cirrhotic nodules and 36 patients with sHCC confirmed by surgical pathology or follow-up were included in our study.The quantitative evaluation indicators,including ADC,CER and T1d%of the lesions,were measured and compared between the two groups.The receiver operator characteristic(ROC)curve was used to analyze the differential diagnosis efficacy of each quantitative parameter.Logistic regression was used to establish a combined diagnosis model with three quantitative parameters.Delong test was used to compare the difference in diagnostic power between a single parameter and a combined parameter.Results A total of 77 lesions in 66 cases were included,including 39 lesions in the cirrhotic nodules group and 38 lesions in the sHCC group.The average ADC,CER and T1d%of the cirrhotic nodule group were(1391.05±160.25)×10^(−3)mm^(2)/s,(97.47±48.37)%,(62.61±13.40)%,respectively.The average ADC,CER and T1d%of the sHCC group were(1081.60±282.12)×10^(−3)mm^(2)/s,(51.10±18.98)%,(47.87±11.86)%,respectively.There were significant differences in the mean ADC,CER values and T1d%of lesions between the two groups(t=5.898,5.563,5.105,all P<0.001).The area under curve(AUC)were 0.821,0.791 and 0.789,respectively.The optimal threshold for differential diagnosis were 1242.70×10^(−3)mm^(2)/s,68.83%and 59.24%,respectively.The AUC of the combined parameter was 0.903,which was significantly higher than that of a single parameter(all P<0.05).Conclusion The ADC,CER and T1d%are valuable for differentiating cirrhotic nodules from s

关 键 词：肝硬化 癌 肝细胞 钆塞酸二钠 磁共振成像 诊断 鉴别 

分 类 号：R445.2[医药卫生—影像医学与核医学] R657.31[医药卫生—诊断学] R735.7[医药卫生—临床医学]