Hussain Hero K, Syed Ibrahim, Nghiem Hanh V, Johnson Timothy D, Carlos Ruth C, Weadock William J, Francis Isaac R
Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr, MRI B2B311, Ann Arbor, MI 48109-0030, USA.
Radiology. 2004 Mar;230(3):637-44. doi: 10.1148/radiol.2303020921. Epub 2004 Jan 22.
To assess if T2-weighted magnetic resonance (MR) imaging provides added diagnostic value in combination with dynamic gadolinium-enhanced MR imaging in the detection and characterization of nodular lesions in cirrhotic liver.
Two readers retrospectively and independently analyzed 54 MR imaging studies in 52 patients with cirrhosis. In session 1, readers reviewed T1-weighted and dynamic gadolinium-enhanced images. In session 2, readers reviewed T1-weighted, dynamic gadolinium-enhanced, and respiratory-triggered T2-weighted fast spin-echo images. Readers identified and characterized all focal lesions by using a scale of 1-4 (1, definitely benign; 4, definitely malignant). Multireader correlated receiver operating characteristic (ROC) analysis was employed to assess radiologist performance in session 2 compared with session 1. The difference in the areas under the ROC curves for the two sessions was tested. In a third session, readers assessed conspicuity of biopsy-proved lesions on T2-weighted MR images by using a scale of 1-3 (1, not seen; 3, well seen) and identified causes of reduced conspicuity.
Two additional benign lesions were detected by each reader in session 2. Fifty-five lesions had pathologic verification, including 32 malignant, three high-grade dysplastic, and 20 benign nodules. There was no significant difference in the area under the ROC curves between the two sessions (P =.48). Thirty-two lesions were inconspicuous on T2-weighted MR images because of parenchymal heterogeneity, breathing artifacts (particularly in patients with ascites), and lesion isointensity with liver parenchyma. T2-weighted MR imaging was useful in the evaluation of cysts and lymph nodes.
T2-weighted MR imaging does not provide added diagnostic value in the detection and characterization of focal lesions in cirrhotic liver.
评估在检测和鉴别肝硬化肝脏中的结节性病变时，T2加权磁共振成像（MR）联合动态钆增强MR成像是否能提供额外的诊断价值。
两位阅片者对52例肝硬化患者的54份MR成像研究进行回顾性独立分析。在第一阶段，阅片者查看T1加权和动态钆增强图像。在第二阶段，阅片者查看T1加权、动态钆增强以及呼吸触发的T2加权快速自旋回波图像。阅片者使用1 - 4级评分（1级，肯定为良性；4级，肯定为恶性）对所有局灶性病变进行识别和特征描述。采用多阅片者相关的接受者操作特征（ROC）分析来评估第二阶段与第一阶段相比阅片者的表现。对两个阶段ROC曲线下面积的差异进行检验。在第三阶段，阅片者使用1 - 3级评分（1级，未看到；3级，清晰看到）评估经活检证实的病变在T2加权MR图像上的显见度，并确定显见度降低的原因。
每位阅片者在第二阶段又检测出2个良性病变。55个病变有病理证实，包括32个恶性、3个高级别发育异常和20个良性结节。两个阶段ROC曲线下面积无显著差异（P = 0.48）。32个病变在T2加权MR图像上不明显，原因包括实质异质性、呼吸伪影（特别是有腹水的患者）以及病变与肝实质等信号。T2加权MR成像在囊肿和淋巴结评估中有用。
T2加权MR成像在检测和鉴别肝硬化肝脏中的局灶性病变时不能提供额外的诊断价值。
