钆塞酸二钠增强磁共振成像对肝脏局灶性病变的诊断价值分析

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(magnetic resonance imaging,MRI)对肝脏局灶性病变的诊断及鉴别价值。材料与方法 34例肝脏局灶性病变患者的Gd-EOB-DTPA增强MRI和手术病理资料纳入本研究。病理证实为20例肝细胞癌(hepatocellular carcinoma,HCC),4例肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC),2例混合型肝癌(combined hepatocellular carcinoma and cholangiocarcinoma,c HCC-CC),7例肝局灶性增生结节(focal nodular hyperplasia,FNH)和1例肝血管平滑肌脂肪瘤(hepatic angiomyolipoma,HAML)。2位高年资放射诊断医师盲法独立分析MRI资料,归纳病灶的Gd-EOBDTPA增强MRI动态3期(动脉期、门脉期、过渡期)强化规律和肝胆期信号特点,并作出影像诊断(含病理类型)。以手术病理结果为标准,评价两位医师诊断结果的准确性和一致性。结果 (1)Gd-EOB-DTPA增强MRI动态3期:5例HCC动态强化特征不典型,包括3例HCC动脉期轻度强化和2例HCC过渡期"廓清"不明显。1例FNH过渡期强化程度低于周围肝实质。2例c HCC-CC动态强化不具特征性,均可见肿瘤供血动脉。余所见无殊。(2)Gd-EOB-DTPA增强MRI肝胆期:1例(1/20,5%)HCC呈高信号,19例(19/20,95%)HCC呈明显低信号。4例ICC均呈低信号内伴云絮状稍高信号,2例c HCC-CC均呈低信号伴中央更低信号。1例(1/7,14.3%)FNH呈稍低信号伴中央"靶征"稍高信号,6例(6/7,85.7%)FNH呈等-稍高信号伴中央星状低信号。1例HAML呈稍低信号强度,其内见更低信号区。(3)两位医师通过Gd-EOB-DTPA增强MRI对病灶的诊断准确率分别为94.12%(32/34)和97.06%(33/34),两者差异无统计学意义(χ~2=0.349,P0.05),诊断结果一致性良好(kappa=0.945,P0.05)。结论钆塞酸二钠增强MRI有助于肝脏局灶性病变诊断和鉴别诊断,具有重要的临床应用价值。

Clinical value of Gd-EOB-DTPA-enhanced MRI for diagnosis of focal hepatic lesions

Objective: To evaluate the application value of Gd-EOB-DTPA-enhanced MRI for diagnosing focal hepatic lesions. Materials and Methods: The Gd-EOB-DTPA- enhanced MRI and clinical datas of 34 cases of focal hepatic leisons were enrolled in this study. The pathological results were 20 cases of hepatocellular carcinoma (HCC), 4 cases of intrahepatic cholangiocarcinoma (ICC), 2 cases of combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC), 7 cases of focal nodular hyperplasia (FNH) and 1 case of hepatic angiomyolipoma (HAML). Two radiologists separately analyzed MRI datas in blind way and made pathological diagnosis. Based on postoperative pathological results, diagnosis veracity and consistency of two radiologists were compared. Results: In dynamic contrast phase of Gd-EOB-DTPA enhanced MRI: 5 cases of HCC turned out to be atypical, including 3 cases of mild-enhanced HCC in arterial phase and 2 cases of HCC without obvious washout in transition phase. 1 case of FNH showed a little lower signal intensity than liver parenchyma in transition phase. 2 cases of cHCC-CC both had irregularly dynamic enhancement feature and possessed obvious feeding artery. In hepatobiliary phase: 1 case of HCC showed high signal intensity while the rest HCC were obviously low signal intensity. 4 cases of ICC performed low singal intensity within cloud mild-high signal intensity. 2 cases of cHCC-CC both were low signal intensity within lower signal intensity in the centre. 1 case of FNH featured slightly-low signal intensity within target high signal intensity. The diagnostic accuracy of two radiologists were 94.12% (32/34) and 97.06% (33/34) and the difference had no statistical significance (χ2=0.349, P>0.05). Furthermore, the diagnosis consistency between radiologists was good(kappa=0.945,P<0.05).Conclusions:Gd-EOB-DTPA enhanced MRI may improve the diagnosis veracity of focal hepatic lesion and it has important clinical value.