Clifford Craig A, Pretorius E Scott, Weisse Chick, Sorenmo Karin U, Drobatz Kenneth J, Siegelman Evan S, Solomon Jeffrey A
University of Pennsylvania School of Veterinary Medicine, Matthew J. Ryan Veterinary Hospital, Philadelphia, PA, USA.
J Vet Intern Med. 2004 May-Jun;18(3):330-8. doi: 10.1892/0891-6640(2004)18<330:mriofs>2.0.co;2.
Focal hepatic and splenic lesions in the dog are common, and approximately half of such lesions are malignant. Both incidentally discovered lesions and lesions in patients with known malignancies represent diagnostic dilemmas. Ultrasound often fails to characterize such lesions adequately. This uncertainty may result in unnecessary splenectomies and liver biopsies for benign lesions or noncurative surgery for advanced-stage malignancies. In humans, ultrasound largely has been supplanted by computed tomography and magnetic resonance imaging (MRI) for the characterization of focal hepatic and splenic lesions. The inherently high soft tissue contrast of MRI allows the differentiation of benign from malignant hepatic and splenic lesions in the human patients. In this prospective study, 35 focal lesions of either the spleen (n = 8) or the liver (n = 27) were characterized by MRI in 23 dogs. Lesions were presumptively classified as malignant or benign on the basis of MRI findings. Imaging results then were correlated with histopathologic (29) or cytologic (6) evaluation of the lesions. The overall accuracy in differentiating malignant from benign lesions was 94% (33 of 35 lesions). The overall sensitivity and specificity were 100% (95% CI, 78-100%) and 90% (95% CI, 68-99%), respectively. MRI classified malignant hepatic lesions as hepatocellular carcinoma (HCC) in all confirmed cases and correctly predicted the histologic grade of 5 HCC lesions. These results suggest that MRI is a useful modality for abdominal imaging in veterinary patients, and MRI accurately differentiated benign from malignant focal hepatic and splenic lesions in this sample of patients.
犬肝脏和脾脏的局灶性病变很常见,其中约一半为恶性病变。偶然发现的病变以及已知恶性肿瘤患者的病变都存在诊断难题。超声往往无法充分明确此类病变的特征。这种不确定性可能导致对良性病变进行不必要的脾切除和肝活检,或者对晚期恶性肿瘤进行非根治性手术。在人类中,超声在很大程度上已被计算机断层扫描和磁共振成像(MRI)所取代,用于肝脏和脾脏局灶性病变的特征描述。MRI固有的高软组织对比度能够区分人类患者肝脏和脾脏的良性与恶性病变。在这项前瞻性研究中,对23只犬的35个脾脏(n = 8)或肝脏(n = 27)局灶性病变进行了MRI检查。根据MRI结果初步将病变分为恶性或良性。然后将影像学结果与病变的组织病理学(29个)或细胞学(6个)评估结果进行关联。区分恶性与良性病变的总体准确率为94%(35个病变中的33个)。总体敏感性和特异性分别为100%(95%CI,78 - 100%)和90%(95%CI,68 - 99%)。在所有确诊病例中,MRI将恶性肝脏病变诊断为肝细胞癌(HCC),并正确预测了5个HCC病变的组织学分级。这些结果表明,MRI是兽医患者腹部成像的一种有用方法,并且在该患者样本中,MRI能准确区分肝脏和脾脏局灶性病变的良性与恶性。