Gd-EOB-DTPA增强MRI肝胆期高信号肝细胞癌的影像表现与鉴别诊断  

Imaging Findings and Differential Diagnosis of Hyperintense Hepatocellular Carcinoma on Hepatobiliary Phase of Gd⁃EOB⁃DTPA⁃enhanced MRI

作　　者：顾季镛 王志刚 邢飞[2] 张涛[2] 陆健[2] 马秦榕 GU Jiyong;WANG Zhigang;XING Fei;ZHANG Tao;LU Jian;MA Qingrong(Department of Radiology,Nantong Haimen People’s Hospital,Nantong 226006,China;Department of Radiology,The Third Affiliated Nantong Hospital of Nantong University;Department of Pathology,The Third Affiliated Nantong Hospital of Nantong University)

机构地区：[1]南通市海门区人民医院影像科 [2]南通大学附属南通第三医院影像科 [3]南通大学附属南通第三医院病理科

出　　处：《中国医学计算机成像杂志》2023年第4期388-393,共6页Chinese Computed Medical Imaging

基　　金：南通市卫生健康委员会科研立项课题(MA2021025)。

摘　　要：目的:探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI肝胆期(HBP)高信号肝细胞癌(HCC)的影像表现与鉴别诊断。方法:回顾性纳入83例患者101个Gd-EOB-DTPA增强MRI显示的HBP高信号病灶,包括29个HCC、24个非HCC恶性病变[胆管细胞癌(ICC)13个、混合型肝细胞癌-胆管癌(cHCC-ICC)4个,肝转移瘤(HM)7个]及48个非HCC良性病变[局灶性结节增生(FNH)及FNH样变25个、异型增生结节(DN)19个、肝腺瘤(HCA)1个、肝海绵状血管瘤(CHL)3个]。2名观察者独立分析病变HBP影像特征,测量并计算HBP病灶-肝脏信号强度比(LLR)。采用ANOVA、Kruskal-Wallis H检验、卡方检验和Fisher精确概率法对HCC、非HCC恶性病变及良性病变的定性、定量参数差异进行分析。采用多因素logistic回归分析筛选HBP高信号HCC与非HCC良、恶性病变鉴别诊断的独立预测因子,并以受试者工作特征(ROC)曲线对高信号HCC的诊断效能进行评估。结果:肝胆期上,高信号HCC主要表现为HBP低信号环(79.3%vs 0%,P<0.001;79.3%vs 12.5%,P<0.001)、对比剂局灶性未摄取(55.2%vs 20.8%,P=0.013;55.2%vs 6.3%,P<0.001)及“结中结”表现(37.9%vs 0%,P<0.001;37.9%vs 0%,P<0.001),非HCC恶性病变主要表现为“EOB云”征(70.8%vs 0%,P<0.001;70.8%vs 0%,P<0.001),非HCC良性病变主要表现为“EOB scar”征(37.5%vs 3.4%,P=0.001;37.5%vs 0%,P<0.001)。HCC、非HCC恶性及良性病变的LLR差异无统计学意义(χ^(2)=1.93,P=0.152)。多因素logistic回归分析显示,HBP低信号环(OR=81.16,95%CI 11.51~572.33;P<0.001)、对比剂局灶性未摄取(OR=11.04,95%CI 1.62~75.39;P=0.014)是诊断高信号HCC的独立预测因子。ROC曲线显示,以HBP低信号环、对比剂局灶性未摄取预测高信号HCC的曲线下面积(AUC)分别为0.862、0.720,两者联合参数AUC为0.882。结论:HBP高信号病变可通过多种影像征象进行鉴别,其中,HBP低信号环、对比剂局灶性未摄取有助于高信号HCC的诊断。Purpose:To investigate imaging findings and differential diagnosis of hyperintense hepatocellular carcinoma(HCC)on hepatobiliary phase(HBP)of Gd-EOB-DTPA-enhanced MRI.Methods:A total of 83 patients with 101 hyperintense nodules depicted on HBP images of Gd-EOB-DTPA were included in this retrospective study.Of the 101 hyperintense nodules,29 were HCCs,24 non-HCC malignant lesions[intrahepatic cholangiocarcinoma(ICC,n=13),combined hepatocellular cholangiocarcinoma(cHCC-ICC,n=4),and hepatic metastases(HM,n=7)],and 48 non-HCC benign lesions[focal nodular hyperplasia(FNH)and FNH-like lesions(FNH/FNH-like lesions,n=25),dysplastic nodules(DN,n=19),hepatic adenoma(HCA,n=1),and cavernous hemangioma of liver(CHL,n=3)].Two observers independently reviewed imaging features and calculated lesion-liver signal intensity ratios(LLR)on HBP images.The ANOVA,Kruskal-Wallis H test,Chi-square test,and Fisher's exact probability method were used to analyze the parameter differences between HCC,non-HCC malignant lesions,and benign lesions.Multivariate logistic regression analysis was employed to identify the independent risk factors of hyperintense HCC and non-HCC hyperintense benign and malignant lesions.Receiver operating characteristic(ROC)curve was used to assess the efficacy of hyperintense HCC.Results:On HBP images,hyperintense HCC was more commonly with HBP hypointense rim(9.3%vs 0%,P<0.001;79.3%vs 12.5%,P<0.001),focal defects in uptake(55.2%vs 20.8%,P=0.013;55.2%vs 6.3%,P<0.001),and"nodule-in-nodule"architecture(37.9%vs 0%,P<0.001;37.9%vs 0%,P<0.001).Non-HCC malignant lesions were more commonly with"EOB cloud"sign(70.8%vs 0%,P<0.001;70.8%vs 0%,P<0.001).Non-HCC benign lesions were more commonly with"EOB scar"sign(37.5%vs 3.4%,P=0.001;37.5%vs 0%,P<0.001).The mean TLR of HCC,non-HCC benign and malignant lesions were with no significant difference(χ^(2)=1.93,P=0.152).Multivariate logistic regression analysis showed that HBP hypointense rim(OR=81.16,95%CI 11.51-572.33;P<0.001)and a focal defect in contrast uptake(OR=11.04,95%CI 1.6

关 键 词：肝细胞癌 钆塞酸二钠 肝胆期低信号环 鉴别诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学]