Huppertz Alexander, Franiel Tobias, Wagner Moritz, Püttcher Olaf, Wagner Joachim, Rief Matthias, Schwenke Carsten, Hamm Bernd, Strassburg Joachim
Imaging Science Institute Charité, Berlin, Germany.
Acta Radiol. 2010 Oct;51(8):842-50. doi: 10.3109/02841851.2010.498443.
In TNM staging of rectal cancer by MRI, unspecific extracellular contrast agent Gd-DTPA is established for extrahepatic and vascular enhancement whereas liver-specific gadoxetic acid has proven high accurate detection of liver metastasis.
To compare intraindividually the qualification and quantification of enhancement in liver parenchyma, abdominal, pulmonary, and pelvic vessels between gadoxetic acid and Gd-DTPA.
Sixteen patients with histologically proven rectal carcinoma (mean age 62.9 years) were imaged twice by MRI. For pretherapeutic staging 10 mL gadoxetic acid (mean dose 0.032 mmol Gd/kg body weight) and for restaging after neoadjuvant therapy Gd-DTPA (0.1 mmol Gd/kg body weight) were administered. The liver was acquired in arterial-dominant and portal venous phases, the thorax and pelvis were depicted in venous phases using three-dimensional T1-weighted sequences. Contrast enhancement was rated by two independent readers and compared by means of multinomial regression analysis using generalized estimating equations. Signal-to-noise ratios were compared by two-sided paired t-tests.
Overall contrast enhancement was rated sufficient for diagnosis in all examinations and both contrast agents. Vascular enhancement was rated comparable with exception of the aorta, the peripheral intrahepatic veins, and the central lung vessels (p = 0.0182, p = 0.0053, p = 0.0083, in favor of Gd-DTPA). Quantitative evaluation revealed no statistically significant differences in parenchymal and vascular signal-to-noise ratios with exception of the aorta, and the central pulmonary artery (67.4 vs. 89.3; p = 0.0421, 44.5 vs. 59.5; p = 0.0446 respectively, in favor of Gd-DTPA).
The contrast enhancement after gadoxetic acid is comparable to Gd-DTPA and appears suitable for comprehensive TNM-staging by combining high accurate liver-specific phases with efficacious vascular enhancement in the different anatomic regions.
在直肠癌的MRI TNM分期中，非特异性细胞外对比剂钆喷酸葡胺（Gd-DTPA）用于肝外及血管增强，而肝脏特异性对比剂钆塞酸二钠已被证明对肝转移具有高准确性的检测能力。
在个体内比较钆塞酸二钠和钆喷酸葡胺在肝实质、腹部、肺部及盆腔血管中的强化定性及定量情况。
16例经组织学证实的直肠癌患者（平均年龄62.9岁）接受了两次MRI检查。在治疗前分期时静脉注射10 mL钆塞酸二钠（平均剂量0.032 mmol钆/千克体重），在新辅助治疗后的再分期时静脉注射钆喷酸葡胺（0.1 mmol钆/千克体重）。在动脉期和门静脉期采集肝脏图像，在静脉期使用三维T1加权序列描绘胸部和盆腔。由两名独立阅片者对对比增强情况进行评分，并使用广义估计方程通过多项回归分析进行比较。通过双侧配对t检验比较信噪比。
在所有检查中，两种对比剂的总体对比增强情况均被评为足以用于诊断。除主动脉、肝内周边静脉和肺中央血管外，血管增强情况被评为相当（p = 0.0182、p = 0.0053、p = 0.0083，钆喷酸葡胺更具优势）。定量评估显示，除主动脉和肺中央动脉外，实质和血管信噪比无统计学显著差异（分别为67.4对89.3；p = 0.0421，44.5对59.5；p = 0.0446，钆喷酸葡胺更具优势）。
钆塞酸二钠后的对比增强与钆喷酸葡胺相当，通过将高准确性的肝脏特异性期相与不同解剖区域有效的血管增强相结合，似乎适用于全面的TNM分期。
