Mori Kensaku, Scheidler Juergen, Helmberger Thomas, Holzknecht Nicolaus, Schauer Rolf, Schirren Carl Albrecht, Bittmann Iris, Dugas Martin, Reiser Maximilian
Department of Clinical Radiology, Klinikum Grosshadern, Ludwig Maximilias University of Munich, Marchioninistr. 15, D-81377 Munich, Germany.
AJR Am J Roentgenol. 2002 Oct;179(4):1045-51. doi: 10.2214/ajr.179.4.1791045.
The purpose of this study was to evaluate the diagnostic accuracy of ferumoxides-enhanced MR imaging for screening malignant hepatic lesions before orthotopic liver transplantation.
The study comprised 48 patients who underwent MR imaging within 6 months before transplantation. Imaging techniques included unenhanced and ferumoxides-enhanced T1-weighted gradient-echo and T2-weighted fast spin-echo sequences and ferumoxides-enhanced T2(*)-weighted gradient-echo sequences. Qualitative and quantitative analyses were performed; the gold standard was the histopathologic reports of explanted livers.
Twenty patients had malignant hepatic lesions, and 24 hepatocellular carcinomas were histopathologically proven. The mean area under the receiver operating characteristic curve and the mean sensitivity were significantly greater for the image sets with ferumoxides-enhanced gradient-echo sequences than for those without these sequences. The mean sensitivity and specificity of all sequences were 85% and 74% on a per-patient basis, respectively. The mean contrast-to-noise ratio was significantly greater for the ferumoxides-enhanced T2(*)-weighted gradient-echo sequences than for any other sequences and for the ferumoxides-enhanced T1-weighted gradient-echo sequences than for unenhanced sequences and the ferumoxides-enhanced T2-weighted fast spin-echo sequences.
Ferumoxides-enhanced gradient-echo sequences improved the diagnostic accuracy and the sensitivity for detecting malignant hepatic lesions in patients with end-stage cirrhosis of the liver. However, the specificity was not improved even after the administration of ferumoxides because of the false-positive lesions that were mainly the result of fibrotic changes.
本研究旨在评估超顺磁性氧化铁增强磁共振成像在原位肝移植术前筛查肝脏恶性病变的诊断准确性。
本研究纳入48例在移植前6个月内接受磁共振成像检查的患者。成像技术包括未增强及超顺磁性氧化铁增强的T1加权梯度回波序列、T2加权快速自旋回波序列以及超顺磁性氧化铁增强的T2*加权梯度回波序列。进行了定性和定量分析；金标准为切除肝脏的组织病理学报告。
20例患者存在肝脏恶性病变，其中24例经组织病理学证实为肝细胞癌。与未使用超顺磁性氧化铁增强梯度回波序列的图像组相比，使用该序列的图像组的平均受试者操作特征曲线下面积和平均敏感度显著更高。所有序列的平均敏感度和特异度在每位患者基础上分别为85%和74%。超顺磁性氧化铁增强的T2*加权梯度回波序列的平均对比噪声比显著高于其他任何序列，超顺磁性氧化铁增强的T1加权梯度回波序列的平均对比噪声比高于未增强序列及超顺磁性氧化铁增强的T2加权快速自旋回波序列。
超顺磁性氧化铁增强梯度回波序列提高了终末期肝硬化患者肝脏恶性病变检测的诊断准确性和敏感度。然而，由于主要由纤维化改变导致的假阳性病变，即使使用了超顺磁性氧化铁，特异度仍未提高。
