Gd-EOB-DTPA增强MRI在乙肝肝硬化 背景下肝癌的诊断价值

目的:探讨Gd-EOB-DTPA增强MRI对乙肝肝硬化背景下肝癌的诊断价值。方法:回顾性分析20例乙肝肝硬化患者经病理证实为肝癌的磁共振成像（MRI）平扫及经典三期动态增强、高b值DWI和Gd-EOB-DTPA增强MRI影像学表现。结果:20例乙肝肝硬化患者发现了25个结节，根据MRI平扫及经典三期动态增强扫描诊断为肝细胞癌共22个，另3个结节诊断肝硬化RN或DN结节；高b值DWI成像诊断肝癌20个，另5个为良性病变；Gd-EOB-DTPA增强MRI扫描诊断肝癌为25个。MRI平扫及经典三期动态增强扫描、高b值DWI成像、Gd-EOB-DTPA增强MRI对肝细胞癌的诊断准确率分别为88%、80%和100%，两者之间的差异有统计学意义（P <0.05）；ROC曲线显示，Gd-EOB-DTPA增强MRI诊断肝癌的敏感度、特异度、准确性要明显高于MRI平扫及经典三期动态增强、高b值DWI单独扫描的敏感度、特异度和准确性，曲线下面积（P <0.05）。结论:Gd-EOB-DTPA增强MRI能提高乙肝肝硬化背景下肝癌的诊断效能，值得临床推广应用。 

The Diagnostic Value of Gd-Eob-Dtpa Enhanced MRI in Hepatocellular Carcinoma in Liver Cirrhosis

Objective: to explore the diagnostic value of gd-eob-dtpa enhanced MRI for liver cancer in the background of liver cirrhosis.Methods: the MRI findings of 20 patients with hepatocellular carcinoma confirmed by pathology were retrospectively analyzed.Results: 25 nodules were found in 20 patients with hepatitis b cirrhosis.A total of 22 nodules were diagnosed as hepatocellular carcinoma by MRI plain scan and classic phase iii dynamic enhancement scan, and the other 3 nodules were diagnosed as RN or DN nodules of cirrhosis.Twenty cases of liver cancer were diagnosed by high-b DWI imaging, and the other five cases were benign lesions.Twenty-five cases of liver cancer were diagnosed by enhanced MRI with gd-eob-dtpa.The diagnostic accuracy of plain MRI and classic phase iii dynamic enhanced MRI, high-b-value DWI imaging, gd-eob-dtpa enhanced MRI for hepatocellular carcinoma was 88%, 80%, and 100%, respectively, with statistically significant differences(P<0.05).ROC curve showed that the sensitivity, specificity and accuracy of gd-eob-dtpa enhanced MRI in the diagnosis of liver cancer were significantly higher than that of plain MRI, classical phase iii dynamic enhancement and high-b-value DWI alone, and the area under the curve(P<0.05).Conclusion: gd-eob-dtpa enhanced MRI can improve the diagnostic efficacy of liver cancer in the context of liver cirrhosis, which is worthy of clinical application.