Xu Peng-ju, Yan Fu-hua, Wang Jian-hua, Lin Jiang, Ji Yuan, Chen Cai-zhong, Shen Ji-zhang, Li Ren-chen
Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Zhonghua Yi Xue Za Zhi. 2009 Mar 10;89(9):592-6.
To evaluate the added value of single breath-hold diffusion-weighted imaging (DWI) in detection of small HCC lesions (<or=3 cm) in patients with chronic liver disease, by comparing the detection sensitivity of DWI/conventional dynamic contrast enhancement (DCE) MRI and that of conventional DCE MRI alone.
A total of 54 patients with chronic liver diseases underwent abdominal MRI at 1.5 T, including T1-weighted (T1WI), T2-weighted (T2WI), and 2D conventional DCE. For each patient study, axial DWI was performed with a single-shot echo-planar imaging (EPI) sequence using modified sensitivity encoding (mSENSE) with b-value of 500 seconds/mm2. A total of 20-24 slices were obtained during a 15-17-second breath-hold. Two observers independently interpreted the combined DWI/conventional DCE MRI images and the conventional DCE MRI images in random order. For all small HCC lesions and micro-hepatocellular carcinoma (smaller than 10 mm MHCC), the diagnostic performance using each imaging techniques were evaluated by ROC analysis. Sensitivity and positive predictive values were also calculated.
The mean areas under the ROC curve (Az) of combined DWI/conventional DCE MRI images (0.945, 0.86) were statistically higher than those of conventional DCE MRI alone (0.86, 0.64) for all small HCC lesions and MHCC (micro hepatocellular carcinoma) lesions (P<0.01). The lesion detection sensitivities using the combined technique of both observers were significantly higher than those using the conventional DCE MRI alone for all small lesions and for MHCC (P<0.01). For MHCC, the sensitivities using the combined technique and the conventional DCE MRI alone were 95.8%-96.0% and 62.5%-68.0%, respectively. The positive predictive values for MHCC using the combined imaging technique (95.8%-96.0%) were higher than those using the conventional DCE MRI alone (94.1%-94.4%) (P<0.05). For all small HCC lesions, the positive predictive values using the combined imaging technique and the conventional DCE MRI alone were 98.6%-98.7% and 95.5%-95.7%, respectively and there was no statistical difference.
Combined use of Breath-hold DWI with conventional DCE MRI helped to provide higher sensitivities than conventional DCE MRI alone in the detection of small HCC lesions in patients with chronic liver disease. Furthermore, DWI could provide additional valuable information that benefits the differential diagnosis.
通过比较弥散加权成像（DWI）/传统动态对比增强（DCE）磁共振成像（MRI）与单纯传统DCE MRI对小肝癌病灶（≤3 cm）的检测灵敏度，评估单次屏气DWI在慢性肝病患者小肝癌病灶检测中的附加价值。
54例慢性肝病患者接受1.5 T腹部MRI检查，包括T1加权成像（T1WI）、T2加权成像（T2WI）及二维传统DCE。对每位患者，采用单次激发回波平面成像（EPI）序列，运用改良灵敏度编码（mSENSE）技术，b值为500 s/mm²进行轴位DWI检查。在15 - 17秒屏气期间获取20 - 24层图像。两名观察者独立且随机地解读DWI/传统DCE MRI联合图像及传统DCE MRI图像。对于所有小肝癌病灶及微小肝细胞癌（直径小于10 mm的MHCC），采用ROC分析评估每种成像技术的诊断性能。同时计算灵敏度和阳性预测值。
对于所有小肝癌病灶及MHCC（微小肝细胞癌）病灶，DWI/传统DCE MRI联合图像的ROC曲线下平均面积（Az）（0.945，0.86）在统计学上高于单纯传统DCE MRI（0.86，0.64）（P<0.01）。两位观察者采用联合技术的病灶检测灵敏度显著高于单纯使用传统DCE MRI对所有小病灶及MHCC的检测灵敏度（P<0.01）。对于MHCC，联合技术与单纯传统DCE MRI的灵敏度分别为95.8% - 96.0%和62.5% - 68.0%。联合成像技术对MHCC的阳性预测值（95.8% - 96.0%）高于单纯传统DCE MRI（94.1% - 94.4%）（P<0.05）。对于所有小肝癌病灶，联合成像技术与单纯传统DCE MRI的阳性预测值分别为98.6% - 98.7%和95.5% - 95.7%，两者无统计学差异。
屏气DWI与传统DCE MRI联合使用在慢性肝病患者小肝癌病灶检测中比单纯传统DCE MRI具有更高的灵敏度。此外，DWI能提供有助于鉴别诊断的额外有价值信息。
