Grazioli Luigi, Morana Giovanni, Kirchin Miles A, Schneider Günther
Department of Radiology, University of Brescia, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25023 Brescia, Italy.
Radiology. 2005 Jul;236(1):166-77. doi: 10.1148/radiol.2361040338. Epub 2005 Jun 13.
To prospectively determine the accuracy of differentiating benign focal nodular hyperplasia (FNH) from hepatic adenoma (HA) and liver adenomatosis (LA) by using gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging.
The ethics committee at each center approved the study, and all patients provided informed consent. Seventy-three patients with confirmed FNH and 35 patients with confirmed HA (n = 27) or LA (n = 8) underwent MR imaging before (T2-weighted half-Fourier rapid acquisition with relaxation enhancement or T2-weighted fast spin-echo and T1-weighted gradient-echo [GRE] sequences) and at 25-30 seconds (arterial phase), 70-90 seconds (portal venous phase), 3-5 minutes (equilibrium phase), and 1-3 hours (delayed phase) after (T1-weighted GRE sequences only, with or without fat suppression) bolus administration of 0.1 mmol per kilogram of body weight gadobenate dimeglumine. The enhancement of 235 lesions (128 FNH, 32 HA, and 75 LA lesions) relative to the normal liver parenchyma was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for the differentiation of FNH from HA and LA were determined.
Hyper- and isointensity on T2-weighted and iso- and hypointensity on T1-weighted GRE images were noted for 177 (88.9%) of 199 lesions visible on unenhanced images. On dynamic phase images after contrast material administration, 231 (98.3%) of 235 lesions showed rapid strong enhancement during the arterial phase and appeared hyper- to isointense during portal venous and equilibrium phases. Accurate differentiation of FNH from HA and LA was not possible on the basis of precontrast or dynamic phase images alone. At 1-3 hours after contrast material enhancement, 124 (96.9%) of 128 FNHs appeared hyper- or isointense, while 107 (100%) HA and LA lesions appeared hypointense. The sensitivity, specificity, PPV, NPV, and overall accuracy for the differentiation of FNH from HA and LA were 96.9%, 100%, 100%, 96.4%, and 98.3%, respectively.
Accurate differentiation of FNH from HA and LA is achievable on delayed T1-weighted GRE images after administration of gadobenate dimeglumine.
前瞻性地确定使用钆贝葡胺增强磁共振成像鉴别良性局灶性结节性增生（FNH）与肝腺瘤（HA）及肝腺瘤病（LA）的准确性。
各中心伦理委员会批准了本研究，所有患者均签署了知情同意书。73例确诊为FNH的患者以及35例确诊为HA（n = 27）或LA（n = 8）的患者在静脉注射每千克体重0.1 mmol钆贝葡胺前（采用T2加权半傅里叶单次激发快速自旋回波序列或T2加权快速自旋回波序列以及T1加权梯度回波序列）和注射后25 - 30秒（动脉期）、70 - 90秒（门静脉期）、3 - 5分钟（平衡期）及1 - 3小时（延迟期）（仅采用T1加权梯度回波序列，有或无脂肪抑制）接受磁共振成像检查。评估了235个病灶（128个FNH、32个HA和75个LA病灶）相对于正常肝实质的强化情况。确定了鉴别FNH与HA及LA的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）及总体准确性。
在未增强图像上可见的199个病灶中，177个（88.9%）在T2加权图像上表现为高信号和等信号，在T1加权梯度回波图像上表现为等信号和低信号。在注射对比剂后的动态期图像上，235个病灶中的231个（98.3%）在动脉期表现为快速强烈强化，在门静脉期和平衡期表现为高信号至等信号。仅根据增强前或动态期图像无法准确鉴别FNH与HA及LA。在对比剂增强后1 - 3小时，128个FNH中的124个（96.9%）表现为高信号或等信号，而107个HA和LA病灶表现为低信号。鉴别FNH与HA及LA的敏感性、特异性、PPV、NPV及总体准确性分别为96.9%、100%、100%、96.4%和98.3%。
注射钆贝葡胺后延迟的T1加权梯度回波图像可实现FNH与HA及LA的准确鉴别。
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