钆塞酸二钠增强MRI肝胆期高信号肝脏占位性病变的研究进展

钆塞酸二钠是一种用于肝脏MRI增强的特异性对比剂,在肝脏肿瘤的检测和定性方面具有重要临床意义。正常肝实质的功能性肝细胞吸收肝胆期钆塞酸二钠后呈高信号,而无功能性肝细胞的肝脏肿瘤通常呈低信号,然而部分肝脏肿瘤在肝胆期中呈高信号。本文阐述肝胆期高信号肝脏肿瘤的影像表现及临床意义,揭示该表现的发生机制,为肝脏肿瘤的诊治提供参考。     

肝脏上皮样血管内皮瘤的钆塞酸二钠增强MRI表现

目的 探讨肝脏上皮样血管内皮瘤(HEHE)的钆塞酸二钠(Gd-EOB-DTPA)增强MRI的表现特征.方法 搜集2017年1月至2019年12月经穿刺或手术病理证实的11例HEHE患者的临床和影像资料.MRI征象包括"棒棒糖"征、血管穿行征、包膜回缩征、病灶融合、晕环征、环形强化以及肝胆期低信号、晕征和核心模式.结果 ...     

钆塞酸二钠在肝脏FNH诊断中的临床价值

目的分析肝脏局灶性结节性增生(FNH)采用钆塞酸二钠行MRI动态增强扫描的表现,探讨此种诊断方法对肝脏FNH诊断的价值。方法我院临床资料完整的肝脏FNH20例,腹痛患者1例,无症状者19例,其中乳腺癌与食道囊肿患者各1例,体检发现17例。对所有患者行肝脏MRI平扫及钆塞酸二钠动态增强扫描。结果肝细胞特异性期增强程度高于肝实质15例,等于肝实质5例;含中央瘢痕12例,T2WI均为高信号,动态增强未见强化。结论采用钆塞酸二钠行MRI动态增强扫描对FNH的诊断有较好的优越性,尤其是病灶内中央瘢痕的显示及肝细胞特异性期病灶实质的强化更具有特异性。     

微小肝细胞癌（≤1cm）的钆塞酸二钠增强MRI表现分析

【摘要】目的：探讨微小肝细胞癌（HCC）的钆塞酸二钠增强MRI表现。方法：回顾性分析125个经病理证实为微小HCC（≤1cm）的钆塞酸二钠增强MRI特征,并比较不同MR序列对微小HCC的检出率。结果：125个微小HCC中,116个（92.8%）DWI与T2WI呈高信号,112个（89.6%）T1WI呈低信号,31个（24.8%）病灶内含脂质,102个（81.6%）动脉期高强化,86个（68.8%）门脉期为低信号,112个（89.6%）过渡期呈低信号,80个（64.0%）可见强化包膜,122个（97.6%）肝胆特异期呈低信号。动态增强67个（53.6%）呈“快进快出”,25个（20.0%）呈“快进慢出”,21个（16.8%）呈相对乏血供,12个（9.6%）呈持续强化。肝胆特异期对微小HCC的检出率（97.6%）高于T1WI（89.6%,P=0.01）、动脉期（81.6%,P<0.01）、门脉期（68.8%,P<0.01）、过渡期（89.6%,P<0.01）及“快进快出”强化（53.6%,P<0.01）。结论：微小HCC钆塞酸二钠增强MRI表现各异,其肝胆特异期结合DWI有助于微小HCC的诊断。     

采用钆塞酸二钠增强MRI肝胆期信号强度评价肝脏功能的临床价值

目的 探讨钆塞酸二钠增强MRI肝胆期肝脏与脾脏信号强度(SI)比(LSC)、肝脏与门静脉SI比(LPC)及门静脉与脾脏SI比(PSC)评价肝硬化患者肝功能的临床价值。方法 选取接受钆塞酸二钠增强MRI检查的128例患者,依据肝功能分为对照组(41例)、Child-Pugh A组(53例)、Child-Pugh B组(26例)和Child-Pugh C组(8例)。记录肝胆期肝脏、门静脉及脾脏SI,并计算LSC、LPC、PSC。采用单因素方差分析比较各组诸SI比值间的差异;采用Spearman线性相关分析比较SI比值与肝功能评分的相关性。结果 LSC及LPC从对照组到Child-Pugh C组逐渐减低(P <0.001),PSC各组间差异无统计学意义。Child-Pugh评分与LSC及LPC呈中度负相关(r值分别为-0.514,-0.530,P均<0.001),MELD评分与LSC及LPC呈中度负相关(r值分别为-0.614,-0.620,P均<0.001)。结论 钆塞酸二钠增强MRI肝胆期LSC及LPC能够反映肝硬化患者肝功能损害的严重程度,可以作为评价肝功能的影像学指...     

钆塞酸二钠增强MRI检查在小肝癌临床诊断中的应用价值

目的 评价Gd-EOB-DTPA MRI检查中肝胆管期对定期复查肝硬化患者检出小肝癌的临床诊断价值.方法 33例肝硬化患者分别进行超声增强检查、Gd-EOB-DTPA增强MRI检查和64排螺旋CT检查共检测出48枚肝脏小结节(直径为10～30 mm),全程使用盲法,以2005年美国肝脏病研究协会标准为诊断标准.结果 48枚肝脏小结节中,38枚(79.2％)被诊断为肝细胞癌,MRI检查中30枚(78.9％)符合典型血管强化征象(快进快出),CT检查有22枚(57.9％),增强超声检查有17枚(44.7％).所有38枚肝细胞癌和3枚良性结节在肝胆管期显示低信号(敏感性100％,特异性70％,阳性预测值93％,阴性预测值100％,阳性似然比3.33,阴性似然比0).38枚肝细胞癌结节中,有7枚在各影像学检查中均不显示典型血管强化征象,有8枚(21.1％)显示为门静脉期廓清,MR肝胆管期低信号征象,此征象未见于良性病变中.结论 Gd-EOB-DTPA MRI检查能提高定期复查的肝硬化患者小肝癌检出的敏感性.门静脉期/静脉期低信号,肝胆管期低信号可以作为MRI最新诊断征象,特别是对乏血供肝细胞癌的检出.     

基于钆塞酸二钠增强MRI联合ADC值的预测模型诊断肝胆期高信号肝细胞癌的价值

目的 探讨钆塞酸二钠增强MRI特征联合ADC值建立Logistic回归预测模型对肝胆期呈高信号的肝细胞癌的预测价值。方法 回顾性分析行钆塞酸二钠增强MRI扫描肝胆期呈高信号的病灶111例,经病理证实分为肝细胞癌37例,良性病灶74例。评估每个病灶的形态及信号特征并测量病灶的直径及ADC值,通过单因素分析及多因素Logistic回归分析确定肝细胞癌的独立预测因素,在纳入或不纳入定量ADC值的情况下分别构建联合预测模型、定性预测模型两种Logistic回归预测模型,使用受试者工作特征(ROC)曲线和DeLong检验分析、比较两种预测模型及平均ADC值的诊断性能。结果 多因素Logistic分析显示肝胆期结节内结节样强化、肝胆期瘤周环形强化、边界不清、DWI高信号、ADC值≤1.303×10^-3mm²/s是诊断肝胆期高信号病变为肝细胞癌的独立预测因素,差异有统计学意义(P<0.05)。联合上述特征构建联合预测模型用于鉴别诊断肝细胞癌与良性病变,ROC曲线下面积为0.931,高于定性预测模型及平均ADC值(AUC分别为0.866、0.871),...     

肝脏血管平滑肌脂肪瘤的钆塞酸二钠增强MRI表现及文献复习

目的分析混合型肝脏血管平滑肌脂肪瘤的钆塞酸二钠(Gd-EOB-DTPA)增强MRI表现及诊断要点。方法 1例因偶然发现肝脏结节性占位病变的60岁老年女性病人进行了肝脏MRI平扫和Gd-EOB-DTPA增强MRI检查,经外科手术切除肝脏病变后,病理诊断为血管平滑肌脂肪瘤。回顾性分析病人的临床资料、MRI表现及病理所见,复习相关文献。结果 MRI检查见肝Ⅷ段一类圆形异常信号影,大小2.0 cm×1.7 cm,边界清楚。病灶在化学位移双回波T_1WI同相位影像呈稍低信号,同层面反相位影像病灶信号强度不均匀减低,快速反转快速自旋回波(FRFSE)脂肪抑制T_2WI呈不均匀高信号,DWI呈稍高信号。静脉注射Gd-EOB-DTPA后动态增强扫描时,病灶在动脉早期因明显不均匀强化呈显著高信号,其内下方见一条迂曲增粗的异常血管连接门静脉分支;在动脉晚期和门静脉期,病灶信号强度略低于周围的肝实质;在平衡期及延迟期,病灶呈不均匀低信号;在20 min及50 min肝胆期,病灶呈明显的低信号。结论混合型肝脏血管平滑肌脂肪瘤的Gd-EOB-DTPA增强MRI表现与富血供肝细胞癌有一定重叠,鉴别诊断需结合临床资料、超声检查及平扫MRI信号特点综合分析。     

钆塞酸二钠肝脏MRI多期增强扫描各期相图像质量的对比研究

目的 比较钆塞酸二钠(Gd-EOB-DTPA)肝脏MRI增强扫描各期相图像的质量,寻找Gd-EOB-DTPA增强扫描呼吸伪影出现的相关因素.方法 回顾性分析近期行Gd-EOB-DTPA MRI增强扫描的患者共250例,由2位放射专业医师采用双盲法对各个期相的图像质量进行评分.结果 动脉早期出现严重呼吸伪影的比例明显高于动脉晚期、门脉期、延迟期及肝胆特异期(比例分别为21.6％、8.8％、5.6％、2.4％和1.2％).动脉早期与动脉晚期(x2=15.89,P=0.000)、门脉期(x2=27.23,P=0.000)、延迟期(x2 =43.64,P=0.000)及肝胆特异期(x2=51.50,P=0.000)呼吸伪影的差异有统计学意义.动脉晚期与延迟期(x2=9.685,P=0.02)及肝胆特异期(x2=15.20,P=0.000)呼吸伪影的差异也有统计学意义.动脉早期、动脉晚期、门脉期、延迟期及肝胆特异期图像质量的分值分别为3.28±1.09、3.65±0.91、3.86±0.85、4.06±0.79和4.19±0.77.在图像质量分值的比较中,动脉早期明显低于其余各期,动脉晚期明显低于延迟期及肝胆特异期,门脉期明显低于肝胆特异期(P均=0.000).结论 MRI Gd-EOB-DTPA增强扫描动脉早期最易出现呼吸伪影,且伪影的程度最为严重.     

Imaging features of intrahepatic cholangiocarcinoma in Gd-EOB-DTPA-enhanced MRI

Objective

The aim of this study is to describe the imaging features of intrahepatic cholangiocarcinoma in Gd-EOB-DTPA-enhanced MRI and to determine whether it results in improved tumour conspicuity of cholangiocarcinoma.

Materials and methods

Fifty-four patients with histologically proven intrahepatic cholangiocarcinoma underwent MRI of the liver using a 1.5 T MR-scanner with Gadoxetic acid disodium (Gd-EOB-DTPA; Eovist/Primovist, Bayer Healthcare, Berlin, Germany). The standard imaging protocol included a T2w multi-shot TSE sequence with fat saturation (fs), a T2w single shot sequence without fs and a T1w 3D GRE sequences with fs (unenhanced and arterial, portovenous, late venous and hepatobiliary phase). Two board certified radiologists experienced in liver MRI (5 and 10 years experience) evaluated retrospectively all MRI scans qualitatively and quantitatively. Signal was measured with region-of-interests (ROI) and signal-to-noise (SNR) as well as contrast-to-noise (CNR) was calculated. Statistical significance was tested with an ANOVA and a pairwise Wilcoxon rank test.

Results

All intrahepatic cholangiocarcinomas presented as hypointense lesions in the late venous and hepatobiliary phase. Images in the hepatobiliary phase showed the highest lesion conspicuity, i.e. n = 9 blurred (16.6%), n = 31 moderate (57.4%) and n = 14 sharp (26%). This was significantly higher than the lesion conspicuity of all other sequences or phases. Furthermore, the CNR was the highest in this sequence with 76.8 ± 51.3, with significantly higher values than the CNR of the unenhanced T1w sequence (CNR: 35.6 ± 21.0; p < 0.0001) and the arterial phase images (CNR: 53.6 ± 36.8; p < 0.001). The hepatobiliary phase images showed a SNR of 97.3 ± 59.7 (p < 0.001) and thus was significantly different from the unenhanced T1w sequence (SNR: 60.4 ± 35.3; p < 0.001), whereas the increase in SNR from the late venous to hepatobiliary phase was neglectable, indicating that no liver-specific contrast uptake is present in cholangiocarcinoma.

Conclusion

Intrahepatic cholangiocarcinoma presents as a hypointense lesion in Gd-EOB-DTPA-enhanced MRI in late venous phase images. The lesion conspicuity as well as CNR was highest in the hepatobiliary phase. Consequently, hepatobiliary phase images in Gd-EOB-DTPA-enhanced MRI images might be helpful for therapy planning due to the exact depiction of the tumour borders.     

Gd-EOB-DTPA增强MRI对肝细胞癌的诊断价值

目的:探究Gd-EOB-DTPA增强MRI对肝细胞瘤(HCC)的诊断价值.方法:纳入因疑诊HCC行Gd-EOB-DTPA增强MRI检查的患者48例.将患者图像分成A、B两组,A组包括平扫图像和动态增强图像;B组包括平扫图像、动态增强图像及肝胆期图像.比较两位阅片者在两组图像下诊断HCC的敏感度、特异度、阳性预测值和阴性预测值,并进行统计学分析.结果:B组图像诊断所有HCC的敏感度及阴性预测值高于A组图像,差异有统计学意义(P＜0.05).B组图像诊断直径＞2.0 cm HCC的阴性预测值高于A组图像,差异有统计学意义(P＜0.05).两位阅片者诊断一致性好(Kappa值均＞0.70).结论:含肝胆期的Gd-EOB-DTPA增强MRI能提高HCC的诊断准确度.     

肝脏乏血供病变的Gd-EOB-DTPA MRI表现

由于肝脏乏血供病变的常规影像表现相似,故术前对病变的良恶性鉴别诊断有一定困难。MRI是肝脏病变诊断最有价值的成像方法,利用非特异性细胞外对比剂钆塞酸二钠（Gd-EOB-DTPA）在肝胆期可以被肝细胞特异性摄取的特点,能够提高病变的检出率和诊断准确性。就多种肝脏乏血供良恶性病变的病生理特点及Gd-EOB-DTPA的MR影像征象予以综述。     

Gd-EOB-DTPA增强MRI定量评估肝脏储备功能的可行性研究

目的:以吲哚氰绿(ICG)15、Child-Pugh评分及终末期肝病模型(MELD)评分为金标准,评估Gd-EOB-DTPA增强MRI定量评估肝脏储备功能的可行性.方法:本研究纳入15例肝脏肿瘤患者及12例肝功能正常志愿者.所有受试者在术前(4周内)均进行了Gd-EOB-DTPA增强MRI检查、ICG清除试验、Child-Pugh评分及MELD评分,以肝细胞摄取率(HUI)作为评估肝脏储备功能的指标.采用Spearmanrank相关检验分析HUI与ICG15、Child-Pugh评分及MELD评分的相关性.结果:HUI与ICG15呈负相关(r=-0.718,P=0.003);HUI与Child-Pugh评分呈负相关(r=-0.663,P=0.007);HUI与MELD评分呈负相关(r=-0.711,P=0.003).12例小肝癌患者不同部位(肝左叶、右叶、尾叶)的HUI差异有统计学意义(P＜0.05)结论:Gd-EOB-DTPA增强MRI可以定量评估肝脏储备功能,并且能对不同叶段的肝脏储备功能进行分别描述.     

Hypovascular hepatic nodule showing hypointensity in the hepatobiliary phase of gadoxetic acid-enhanced MRI in patients with chronic liver disease: prediction of malignant transformation

Purpose

To investigate the predictive factors of malignant transformation of hypovascular hepatic nodule showing hypointensity in the hepatobiliary phase images of gadoxetic acid-enhanced MRI (HHN).

Materials and Methods

The clinical data and imaging findings of dynamic contrast-enhanced computed tomography (DCE-CT) and gadoxetic acid-enhanced MRI for a total of 103 HHNs in 24 patients with chronic liver disease were retrospectively investigated. After the results of follow-up examinations were investigated, HHNs were categorized into the three groups for each comparison: (1) nodules with enlargement and/or vascularization and others, (2) nodules with only enlargement and others, (3) nodules with only vascularization and others. Enlargement and/or vascularization during the follow-up period were defined as malignant transformation of HHN. The frequency of each clinical datum and imaging finding in each group was compared to identify the predictive factors for malignant transformation in HHN.

Results

Multivariate analysis showed that a nodule size of 9 mm or more on the initial gadoxetic acid-enhanced MRI was a significant predictive factor for the enlargement and/or vascularization of HHN (P < 0.05). On the other hand, the hypoattenuation on the delayed phase imaging of the initial DCE-CT was a significant predictive factor for the enlargement or vascularization of HHN (P < 0.05).

Conclusion

A nodule size of 9 mm or more on the initial gadoxetic acid-enhanced MRI and hypoattenuation on the delayed phase imaging of initial DCE-CT would be helpful for predicting the outcome of HHN in patients with a risk of hepatocellular carcinoma.     

Detection and classification of different liver lesions: Comparison of Gd-EOB-DTPA-enhanced MRI versus multiphasic spiral CT in a clinical single centre investigation

Objective

To compare the diagnostic efficacy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) vs. multidetector computed tomography (MDCT) for the detection and classification of focal liver lesions, differentiated also for lesion entity and size; a separate analysis of pre- and postcontrast images as well as T2-weighted MRI sequences of focal and exclusively solid lesions was integrated.

Methods

Twenty-nine patients with 130 focal liver lesions underwent MDCT (64-detector-row; contrast medium iopromide; native, arterial, portalvenous, venous phase) and MRI (1.5-T; dynamic and tissue-specific phase 20 min after application of Gd-EOB-DTPA). Hepatic lesions were verified against a standard of reference (SOR). CT and MR images were independently analysed by four blinded radiologists on an ordinal 6-point-scale, determining lesion classification and diagnostic confidence.

Results

Among 130 lesions, 68 were classified as malignant and 62 as benign by SOR. The detection of malignant and benign lesions differed significantly between combined and postcontrast MRI vs. MDCT; overall detection rate was 91.5% for combined MRI and 80.4% for combined MDCT (p < 0.05). Considering all four readers together, combined MDCT achieved sensitivity of 66.2%, specificity of 79.0%, and diagnostic accuracy of 72.3%; combined MRI reached superior diagnostic efficacy: sensitivity 86.8%, specificity 94.4%, accuracy 90.4% (p < 0.05). Differentiated for lesion size, in particular lesions <20 mm revealed diagnostic benefit by MRI. Postcontrast MRI also achieved higher overall sensitivity, specificity, and accuracy compared to postcontrast MDCT for focal and exclusively solid liver lesions (p < 0.05).

Conclusion

Combined and postcontrast Gd-EOB-DTPA-enhanced MRI provided significantly higher overall detection rate and diagnostic accuracy, including low inter-observer variability, compared to MDCT in a single centre study.     

Gd-EOB-DTPA增强MRI对Oddi括约肌及胆囊管功能的动态评估

目的:探讨正常志愿者行Gd-EOB-DTPA动态增强MRI中,Gd-EOB-DTPA在十二指肠内及胆囊内显影的时间,为胆道系统功能障碍疾病的诊断提供依据.方法:前瞻性纳入30例行Gd-EOB-DTPA MRI增强扫描的志愿者,于注射对比剂后第5～90 min内连续动态扫描.扫描时间点分别为第5～30 min内每间隔1 min、第30～60min内每间隔5 min、第60～90 min内每间隔10 min采集一次图像.由2位放射科医生对图像进行共同评估,记录对比剂分别进入十二指肠及胆囊的时间.结果:Gd-EOBDTPA进入十二指肠的平均时间为(30±23) min,其中注射Gd-EOB-DTPA延迟扫描20 min时,对比剂进入十二指肠者所占比例为50.0％(15/30);延迟30 min时所占比例为70.0％(21/30);延迟60 min时所占比例为90.0％(27/30).对比剂进入胆囊的中位时间为10 min(6～29 min),其中注射Gd-EOB-DTPA延迟扫描15 min时,对比剂进入胆囊者所占比例为83.3％(25/30);延迟20 min时所占比例为93.3％(28/30);延迟30 min时所占比例为100％(30/30).对比剂进入十二指肠及胆囊时间与年龄无关(P＞0.05).结论:正常人行Gd-EOB-DTPA MRI增强扫描中,对比剂通过十二指肠乳头进入十二指肠的时间＜60 min,而通过胆囊管进入胆囊的时间＜30 min,此时间不仅可为Gd-EOB-DTPA MRI增强检查扫描时间方案的制定提供指导,同时可为临床上怀疑Oddi括约肌功能障碍或急性胆囊炎的排除诊断提供依据.