Semelka R C, Martin D R, Balci C, Lance T
Department of Radiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
J Magn Reson Imaging. 2001 Mar;13(3):397-401. doi: 10.1002/jmri.1057.
The purpose of this study was to compare dual-phase spiral computed tomography (CT) and magnetic resonance imaging (MRI) using dynamic gadolinium enhancement for liver lesion detection and characterization. Twenty-two consecutive patients underwent dual-phase spiral CT and MRI for the evaluation of focal liver disease within a 1-month period. Spiral CT and MR images were interpreted prospectively, in a blinded fashion by separate, individual, experienced investigators, to determine lesion detection and characterization. Liver lesions were confirmed by surgery and pathology in 6 patients, and by clinical and imaging follow-up in the other 16 patients. Pathological correlation of a primary extrahepatic malignancy was available in 5 of the 16 patients who had metastatic liver disease. Spiral CT and MRI detected 53 and 63 lesions, and characterized 39 and 62 true positive lesions, respectively. A kappa statistic test was applied to assess agreement between MR and CT results. MR versus CT for lesion detection resulted in a kappa statistic of 0.54 (95% confidence interval), indicating moderate agreement, and 0.32 (95% confidence interval) for lesion characterization, indicating only slight agreement. More lesions were detected on MR images than CT images in 6 (27%) patients, with lesions detected only on MR images in 4 (18%) patients. More lesions were characterized on MR images in 9 (41%) patients. In 9 patients with a discrepancy between MR and CT findings, the MR images added information considered significant to patient management in all 9 cases. MRI was moderately superior to dual-phase spiral CT for lesion detection, and was markedly superior for lesion characterization, with these differences having clinical significance.
本研究的目的是比较双期螺旋计算机断层扫描（CT）和使用动态钆增强的磁共振成像（MRI）在肝脏病变检测和特征描述方面的效果。22例连续患者在1个月内接受了双期螺旋CT和MRI检查，以评估局灶性肝病。螺旋CT和MR图像由独立、经验丰富的研究者以盲法进行前瞻性解读，以确定病变的检测和特征描述。6例患者的肝脏病变经手术和病理证实，另外16例患者经临床和影像学随访证实。16例有肝转移瘤的患者中有5例获得了原发性肝外恶性肿瘤的病理相关性。螺旋CT和MRI分别检测到53个和63个病变，并分别对39个和62个真阳性病变进行了特征描述。应用kappa统计检验来评估MR和CT结果之间的一致性。对于病变检测，MR与CT的kappa统计值为0.54（95%置信区间），表明中度一致；对于病变特征描述，kappa统计值为0.32（95%置信区间），表明仅轻微一致。6例（27%）患者的MR图像上检测到的病变比CT图像上多，4例（18%）患者仅在MR图像上检测到病变。9例（41%）患者的MR图像上对更多病变进行了特征描述。在9例MR和CT结果存在差异的患者中，MR图像在所有9例中都提供了对患者管理具有重要意义的信息。MRI在病变检测方面中度优于双期螺旋CT，在病变特征描述方面明显优于双期螺旋CT，这些差异具有临床意义。
