Scharitzer Martina, Schima Wolfgang, Schober Ewald, Reimer Peter, Helmberger Thomas K, Holzknecht Nicolaus, Stadler Alfred, Ba-Ssalamah Ahmed, Weber Michael, Wrba Friedrich
Department of Radiology, Medical University of Vienna, Vienna, Austria.
J Comput Assist Tomogr. 2005 Mar-Apr;29(2):181-90. doi: 10.1097/01.rct.0000156397.51640.a1.
To assess the value of mangafodipir trisodium-enhanced MR imaging for characterization of hepatocellular lesions.
Magnetic resonance images of 41 patients with 48 histopathologically proven hepatocellular lesions (20 cases of focal nodular hyperplasia [FNH], 4 adenomas, 15 hepatocellular carcinomas [HCCs], 7 regenerative nodules, and 2 others) were retrospectively studied. Magnetic resonance imaging was performed on a 1.5-T unit (Vision, Siemens, Erlangen, Germany; ACS-NT, Philips, Best, The Netherlands) using T2-weighted, fat-saturation, turbo spin echo imaging and T1-weighted gradient echo imaging before and 20 minutes after infusion of 5 micromol/kg mangafodipir (Amersham Health, Oslo, Norway). Qualitative analysis by 4 blinded independent readers included assessment of unenhanced images and, in a second step, assessment of unenhanced and contrast-enhanced images together. Lesions were classified as benign or malignant using a 5-point scale, and readers made a specific diagnosis.
For characterization of hepatocellular lesions, mangafodipir-enhanced imaging was significantly superior to unenhanced imaging (P < 0.05). On receiver operating characteristic analysis, the area under the curve was 0.768 (95% confidence interval: 0.633-0.903) for unenhanced images and 0.866 (95% confidence interval: 0.767-0.966) for evaluation of unenhanced and contrast-enhanced images together (P < 0.05). Analysis of enhancement patterns aided in characterization and classification of tumors.
Administration of mangafodipir improves the differentiation between adenoma or HCC and "nonsurgical" lesions (FNH or regenerative nodules). The accuracy for arriving at a specific diagnosis is higher when unenhanced and mangafodipir-enhanced images are considered together than for unenhanced MR images alone.
评估锰福地匹三钠增强磁共振成像在肝细胞性病变特征诊断中的价值。
回顾性研究41例患者的48个经组织病理学证实的肝细胞性病变的磁共振图像(20例局灶性结节性增生[FNH]、4例腺瘤、15例肝细胞癌[HCC]、7例再生结节和2例其他病变)。使用1.5-T设备(德国埃尔兰根西门子公司的Vision;荷兰贝斯特飞利浦公司的ACS-NT)进行磁共振成像,在静脉注射5 μmol/kg锰福地匹(挪威奥斯陆阿美仙医药公司)前及注射后20分钟,采用T2加权、脂肪抑制、快速自旋回波成像和T1加权梯度回波成像。4名独立的盲法读者进行定性分析,包括对平扫图像的评估,第二步是对平扫和增强图像进行综合评估。采用5分制将病变分为良性或恶性,读者做出具体诊断。
对于肝细胞性病变的特征诊断,锰福地匹增强成像显著优于平扫成像(P < 0.05)。在接受者操作特征分析中,平扫图像的曲线下面积为0.768(95%可信区间:0.633 - 0.903),平扫和增强图像综合评估的曲线下面积为0.866(95%可信区间:0.767 - 0.966)(P < 0.05)。增强模式分析有助于肿瘤的特征诊断和分类。
锰福地匹的应用提高了腺瘤或HCC与“非手术”病变(FNH或再生结节)之间的鉴别能力。平扫和锰福地匹增强图像综合考虑时得出具体诊断的准确性高于单独的平扫磁共振图像。