使用钆塞酸增强磁共振成像鉴别肝脏富血管性假病变与富血管性肝细胞癌。
Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging.
机构信息
Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
出版信息
Radiology. 2010 Jul;256(1):151-8. doi: 10.1148/radiol.10091885.
PURPOSE
To retrospectively determine findings at gadoxetic acid-enhanced magnetic resonance (MR) imaging in hypervascular pseudolesions that were observed at computed tomography (CT) during hepatic arteriography, with special focus on distinguishing these pseudolesions from hypervascular hepatocellular carcinomas (HCCs).
MATERIALS AND METHODS
The institute ethics committee deemed study approval unnecessary. The study population comprised 80 patients (55 men, 25 women) with chronic liver disease who underwent CT during hepatic arteriography and arterial portography, gadoxetic acid-enhanced MR imaging, and follow-up dynamic contrast material-enhanced CT. The diagnosis of 104 pseudolesions and 123 HCCs was confirmed by means of histopathologic or multimodality evaluation. Two radiologists assessed the MR imaging findings of HCCs and pseudolesions in consensus, including the signal intensities (SIs) of the lesions on T2-weighted, diffusion-weighted (DW), and contrast-enhanced hepatocyte-phase images. The findings of nodular pseudolesions and HCCs were compared with the Fisher exact test. Additionally, the hepatocyte-phase SI ratio (ratio of lesion SI to liver SI) for HCCs and pseudolesions was compared by means of the Mann-Whitney U test.
RESULTS
There were 62 wedge-shaped, 32 nodular, and 10 linear pseudolesions. On gadoxetic acid-enhanced hepatocyte-phase MR images, 15% of pseudolesions (16 of 104) were hypointense compared with surrounding liver tissue. The mean hepatocyte-phase SI ratio of HCCs (0.65 +/- 0.14 [standard deviation]) was significantly lower (P < .01) than that of the nodular pseudolesions (0.95 +/- 0.11). The optimal cutoff value of hepatocyte-phase SI ratio for distinguishing between HCC and nodular pseudolesion was 0.84. No nodular pseudolesions were visible on DW images.
CONCLUSION
Gadoxetic acid-enhanced hepatocyte-phase MR imaging and DW imaging could be used to distinguish hypervascular pseudolesions from hypervascular HCCs; a hepatocyte-phase SI ratio below 0.84 and visibility on DW images were findings specific for HCCs rather than pseudolesions.
目的
回顾性分析经动脉造影 CT 检查时肝动脉造影中观察到的富血管性假性病变的钆塞酸增强磁共振成像（MR）表现，重点在于将这些假性病变与富血管性肝细胞癌（HCC）区分开来。
材料与方法
本机构伦理委员会认为本研究无需批准。该研究人群包括 80 例患有慢性肝病的患者（55 名男性，25 名女性），他们在经动脉造影和动脉门静脉造影期间接受了 CT 检查、钆塞酸增强 MR 成像以及随访的动态对比增强 CT 检查。通过组织病理学或多模态评估确定了 104 个假性病变和 123 个 HCC 的诊断。两位放射科医生对 HCC 和假性病变的 MR 成像表现进行了评估，包括 T2 加权像、弥散加权（DW）像和对比增强肝细胞相上病变的信号强度（SI）。通过 Fisher 确切检验比较结节性假性病变和 HCC 的发现。此外，通过 Mann-Whitney U 检验比较 HCC 和假性病变的肝细胞相 SI 比值（病变 SI 与肝 SI 的比值）。
结果
有 62 个楔形、32 个结节状和 10 个线性假性病变。在钆塞酸增强肝细胞相 MR 图像上，15%的假性病变（104 个中的 16 个）与周围肝组织相比呈低信号。HCC 的平均肝细胞相 SI 比值（0.65±0.14[标准差]）明显低于（P<0.01）结节状假性病变（0.95±0.11）。用于区分 HCC 和结节状假性病变的肝细胞相 SI 比值最佳截断值为 0.84。DW 图像上未见结节状假性病变。
结论
钆塞酸增强肝细胞相 MR 成像和 DW 成像可用于区分富血管性假性病变与富血管性 HCC；肝细胞相 SI 比值低于 0.84 且在 DW 图像上可见是 HCC 而非假性病变的特异性表现。
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