钆塞酸二钠增强MRI对不典型肝脓肿与单发肝转移瘤的鉴别诊断  

Gadoxetic Acid Disodium-Enhanced MRI in Differential Diagnosis of Atypical Hepatic Abscess from Solitary Hepatic Metastasis

作　　者：何旭 韩鼎盛 黎雅琳 张嘉诚 黄婷婷[2] 周彦汝 张岚[3,4] HE Xu;HAN Dingsheng;LI Yalin;ZHANG Jiacheng;HUANG Tingting;ZHOU Yanru;ZHANG Lan(不详;Department of MRI,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;Zhengzhou Key Laboratory of Information Intelligence Analysis and Utilization of Traditional Chinese Medicine,Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学,河南郑州450046 [2]河南中医药大学第一附属医院放射科,河南郑州450000 [3]河南中医药大学第一附属医院MRI科,河南郑州450000 [4]河南中医药大学中医药信息智能分析与利用郑州市重点实验室,河南郑州450000

出　　处：《中国医学影像学杂志》2023年第11期1157-1163,共7页Chinese Journal of Medical Imaging

基　　金：医学科学研究基金2022年科研项目(YWJKJJHKYJJ-BXS5-22039);河南省自然科学基金(232300421187)。

摘　　要：目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI对不典型肝脓肿(AHA)和单发肝转移瘤(SHM)的鉴别诊断价值。资料与方法回顾性收集2019年9月—2023年2月河南中医药大学第一附属医院经病理证实的36例AHA和48例SHM的影像及临床资料。患者均行肝脏扩散加权成像(DWI)和Gd-EOB-DTPA增强MRI扫描。比较两组患者的影像学特征及临床指标。使用Logistic回归分析模型筛选出AHA的独立预测指标,采用受试者工作特征曲线分析各独立因素及其联合预测AHA的诊断效能。结果AHA组多见DWI非环形高信号(33/36)、肝胆期病灶边缘非缺损区(32/36)(OR=9.308,95%CI 2.508~34.537);SHM组多见DWI靶样高信号(22/48)、肝胆期病灶边缘缺损区(36/48)(OR=24.000,95%CI 7.031~81.921;P均<0.05)。DWI非环形高信号(OR=5.467,95%CI 1.206~24.789)、肝胆期病灶边缘非缺损区(OR=18.611,95%CI 5.254~65.922)是诊断AHA的独立预测因素(P均<0.05),DWI非环形高信号、肝胆期病灶边缘非缺损区及两者联合诊断AHA的曲线下面积分别为0.688、0.819和0.860;准确度分别为66.7%、80.9%和83.3%。结论Gd-EOB-DTPA增强MRI对AHA与SHM的鉴别诊断具有重要价值,DWI非环形高信号联合肝胆期病灶边缘非缺损区能够提高AHA的诊断效能。Purpose To investigate the diagnostic value of gadoxetic acid disodium(Gd-EOB-DTPA)enhanced MRI in differentiating of atypical hepatic abscess(AHA)from solitary hepatic metastasis(SHM).Materials and Methods The imaging and clinical data of 36 patients with AHA and 48 patients with SHM pathologically confirmed in the First Affiliated Hospital of Henan University of Chinese Medicine from September 2019 to February 2023 were retrospectively collected.All patients underwent diffusion-weighted imaging(DWI)and Gd-EOB-DTPA enhanced MRI examinations.The imaging characteristics and clinical indicators were compared between the two groups.The independent predictors were selected by Logistic regression analysis and the receiver operating characteristic curve was used to analyze the efficacy of each independent indicator and its combination in the diagnosis of AHA.Results Non-peripheral hyperintensity on DWI(33/36)and the peripheral non-defect zone on hepatobiliary phase(HBP,32/36)were more common in AHA group;targetoid hyperintensity on DWI(22/48)and peripheral defect zone on HBP(36/48)were more common in SHM group(OR=9.308,95%CI 2.508-34.537;OR=24.000,95%CI 7.031-81.921,both P<0.05).Non-peripheral hyperintensity on DWI(OR=5.467,95%CI 1.206-24.789)and peripheral non-defect zone on HBP(OR=18.611,95%CI 5.254-65.922)were independent predictive factors for the diagnosis of AHA(both P<0.05).The area under the curves of non-peripheral hyperintensity on DWI,peripheral non-defect zone on HBP and their combination in the diagnosis of AHA were 0.688,0.819 and 0.860,respectively;and the diagnostic accuracy were 66.7%,80.9%and 83.3%,respectively.Conclusion Gd-EOB-DTPA-enhanced MRI is of great value in differentiating of AHA from SHM,non-peripheral hyperintensity on DWI combined with the peripheral non-defect zone on HBP can improve the diagnostic performance of AHA.

关 键 词：不典型肝脓肿 单发肝转移瘤 钆塞酸二钠 肝胆特异期 扩散加权成像 诊断 鉴别 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]