Dromain Clarisse, de Baere Thierry, Baudin Eric, Galline Joel, Ducreux Michel, Boige Valérie, Duvillard Pierre, Laplanche Agnès, Caillet Hubert, Lasser Philippe, Schlumberger Martin, Sigal Robert
Department of Imaging, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France.
AJR Am J Roentgenol. 2003 Jan;180(1):121-8. doi: 10.2214/ajr.180.1.1800121.
The aim of our prospective study was to assess the MR imaging characteristics of hepatic metastases of neuroendocrine tumors and to determine the optimal MR sequence for their detection.
Thirty-seven consecutive patients with liver metastases from neuroendocrine tumors underwent 1.5-T MR imaging of the liver comprising T2-weighted fast spin-echo with respiratory monitoring, breath-hold T2-weighted single-shot fast spin-echo, and T1-weighted gradient-recalled echo sequences before and after the injection of gadoterate dimeglumine. Images were reviewed independently by three observers for the number, location, and pattern of signal and enhancement of metastases.
A total of 359 metastases were detected, 279 on T2-weighed fast spin-echo, 231 on T2-weighed single-shot fast spin-echo, 272 on unenhanced T1-weighted, 322 on hepatic arterial phase, and 228 on portal venous phase images. Hepatic arterial phase images revealed the greatest number of metastases in 70% of patients, including 35 metastases seen only on this sequence, and was significantly superior to the unenhanced T1-weighted and portal venous phase sequences (p < 0.01). The lesion-to-liver contrast was significantly greatest with T2-weighed fast spin-echo sequences. The enhancement patterns of metastases were predominantly hypervascular, hypovascular, peripheral with progressive fill-in, and delayed in, respectively, 27, four, four, and two patients. Most metastases with peripheral enhancement and progressive fill-in were heterogeneous on T2-weighted images and were without globular peripheral enhancement.
Hepatic metastases of neuroendocrine tumors had a typical hypervascular pattern in 73% of patients. Hepatic arterial phase and fast spin-echo T2-weighed sequences are the most sensitive.
我们这项前瞻性研究的目的是评估神经内分泌肿瘤肝转移的磁共振成像（MR）特征，并确定用于检测这些转移灶的最佳MR序列。
37例连续的神经内分泌肿瘤肝转移患者接受了1.5-T肝脏MR成像检查，包括呼吸门控的T2加权快速自旋回波序列、屏气T2加权单次激发快速自旋回波序列以及注射钆双胺前后的T1加权梯度回波序列。三名观察者独立回顾图像，观察转移灶的数量、位置、信号及强化方式。
共检测到359个转移灶，T2加权快速自旋回波序列上发现279个，T2加权单次激发快速自旋回波序列上发现231个，未增强T1加权序列上发现272个，肝动脉期发现322个，门静脉期发现228个。肝动脉期图像在70%的患者中显示出最多的转移灶，其中35个转移灶仅在此序列上可见，显著优于未增强T1加权序列和门静脉期序列（p < 0.01）。T2加权快速自旋回波序列的病灶与肝脏对比度显著最高。转移灶的强化方式主要为富血供、乏血供、周边渐进性填充和延迟强化，分别见于27例、4例、4例和2例患者。大多数周边强化和渐进性填充的转移灶在T2加权图像上不均匀，且无球状周边强化。
73%的神经内分泌肿瘤肝转移患者具有典型的富血供模式。肝动脉期和快速自旋回波T2加权序列最为敏感。
