基于2018版LI-RADS对比国产钆塞酸二钠和钆喷酸葡胺增强MRI对小肝细胞癌的诊断效能  

The diagnostic efficacy of domestic gadoxetic acid disodium and gadopentetate meglumine-enhanced MRI on small hepatocellular carcinoma:A comparative study based on the 2018 version of LI-RADS

作　　者：夏瑞可 施德恩 贾庆 王晓阳 XIA Ruike;SHI Deen;JIA Qing;WANG Xiaoyang(Department of Radiology,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,China.)

机构地区：[1]温州医科大学附属第三医院放射科,浙江温州325200

出　　处：《温州医科大学学报》2025年第4期316-321,328,共7页Journal of Wenzhou Medical University

基　　金：瑞安市科技局项目(MS2022033)。

摘　　要：目的:基于2018版肝脏影像报告和数据系统(LI-RADSv2018),通过对比钆喷酸葡胺(Gd-DTPA)增强MRI,探讨采用国产钆塞酸二钠(Gd-EOB-DTPA)对比剂的增强MRI对高危人群小肝细胞癌(HCC)的诊断效能。方法:回顾性分析瑞安市人民医院2020年4月至2023年12月,在1周内同时行Gd-EOB-DTPA增强MRI和GdDTPA增强MRI,并于半个月内进行肝切除术的68例肝硬化高危结节患者(82枚局灶性肝脏病灶)。根据LIRADSv2018评估每枚病灶的主要征象、辅助征象及LI-RADS分级,以病理结果为金标准,分别计算Gd-EOB-DTPA增强MRI和Gd-DTPA增强MRI以LR-4+5为标准对小HCC的诊断效能,包括灵敏度、特异度、阳性预测值、阴性预测值、准确度和约登指数,并采用配对样本McNemar检验比较两者差异。结果:Gd-EOB-DTPA增强MRI灵敏度、特异度、阳性预测值、阴性预测值、准确度和约登指数分别为90%(54/60)、63.64%(14/22)、87.10%(54/62)、70.00%(14/20)、82.93%(68/82)、0.536;Gd-DTPA增强MRI分别为80.00%(48/60)、81.82%(18/22)、92.31%(48/52)、60.00%(18/30)、80.49%(66/82),0.618。两者在灵敏度上差异有统计学意义(P=0.031),其余效能指标差异无统计学意义(P>0.05)。结论:基于LI-RADSv2018,国产Gd-EOB-DTPA增强MRI能明显提高诊断HCC的灵敏度,减少漏诊。Objective:To investigate the diagnostic efficacy of domestic gadoxetic acid disodium(Gd-EOB-DTPA)contrast-enhanced MRI and Gd-DTPA-enhanced MRI for small hepatocellular carcinoma(HCC)in high-risk groups,based on the 2018 version of the Liver Imaging Reporting and Data System(LI-RADSv2018).Methods:A retrospective analysis was made of 68 patients with high-risk nodules of cirrhosis(82 focal liver lesions)who underwent simultaneous Gd-EOB-DTPA-enhanced MRI and Gd-DTPA-enhanced MRI within one week and underwent hepatectomy within half a month from April 2020 to December 2023 in Rui’an People’s Hospital.The main signs,auxiliary signs and LI-RADS grade of each lesion were evaluated according to the 2018 version of LI-RADS.Taking the pathological results as the gold standard,the diagnostic efficacy of Gd-EOB-DTPA-enhanced MRI and Gd-DTPA-enhanced MRI for small HCC with LR-4+5 as the standard was calculated,including sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index,and their differences were compared by paired sample McNemar test.Results:The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index of Gd-EOB-DTPA-enhanced MRI were 90%(54/60),63.64%(14/22),87.10%(54/62),70.00%(14/20),82.93%(68/82)and 0.536,respectively.Gd-DTPA-enhanced MRI were 80.00%(48/60),81.82%(18/22),92.31%(48/52),60.00%(18/30),80.49%(66/82),0.618,respectively.The difference in sensitivity between the two groups was statistically significant(P=0.031),and the other efficacy indicators were not statistically significant.Conclusion:Domestic Gd-EOB-DTPA enhanced MRI based on LI-RADSv2018 can significantly improve the sensitivity of HCC diagnosis and reduce missed diagnosis.

关 键 词：钆塞酸二钠 钆喷酸葡胺 诊断效能 磁共振 增强扫描 

分 类 号：R445.2[医药卫生—影像医学与核医学]