Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, UK.
Br J Radiol. 2012 Jul;85(1015):980-9. doi: 10.1259/bjr/91771639. Epub 2011 Dec 13.
To compare the diagnostic accuracy of gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, diffusion-weighted MRI (DW-MRI) and a combination of both techniques for the detection of colorectal hepatic metastases.
72 patients with suspected colorectal liver metastases underwent Gd-EOB-DTPA MRI and DW-MRI. Images were retrospectively reviewed with unenhanced T(1) and T(2) weighted images as Gd-EOB-DTPA image set, DW-MRI image set and combined image set by two independent radiologists. Each lesion detected was scored for size, location and likelihood of metastasis, and compared with surgery and follow-up imaging. Diagnostic accuracy was compared using receiver operating characteristics and interobserver agreement by kappa statistics.
417 lesions (310 metastases, 107 benign) were found in 72 patients. For both readers, diagnostic accuracy using the combined image set was higher [area under the curve (Az)=0.96, 0.97] than Gd-EOB-DTPA image set (Az=0.86, 0.89) or DW-MRI image set (Az=0.93, 0.92). Using combined image set improved identification of liver metastases compared with Gd-EOB-DTPA image set (p<0.001) or DW-MRI image set (p<0.001). There was very good interobserver agreement for lesion classification (κ=0.81-0.88).
Combining DW-MRI with Gd-EOB-DTPA-enhanced T(1) weighted MRI significantly improved the detection of colorectal liver metastases.
比较钆塞酸二乙三胺五乙酸（Gd-EOB-DTPA）增强 MRI、弥散加权 MRI（DW-MRI）及两者联合技术对结直肠肝转移的诊断效能。
72 例疑似结直肠肝转移患者接受 Gd-EOB-DTPA MRI 和 DW-MRI 检查。由 2 位独立的放射科医师对未增强 T1 和 T2 加权图像（Gd-EOB-DTPA 图像组、DW-MRI 图像组和联合图像组）进行回顾性分析。对每个检测到的病变的大小、位置和转移可能性进行评分，并与手术和随访影像学进行比较。采用受试者工作特征曲线比较诊断准确性，采用 Kappa 统计比较观察者间的一致性。
72 例患者共发现 417 个病变（310 个转移灶，107 个良性病变）。对于两位观察者，联合图像组的诊断准确性均较高[曲线下面积（Az）=0.96、0.97]，高于 Gd-EOB-DTPA 图像组（Az=0.86、0.89）或 DW-MRI 图像组（Az=0.93、0.92）。与 Gd-EOB-DTPA 图像组（p<0.001）或 DW-MRI 图像组（p<0.001）相比，联合图像组可提高肝转移的检出率。观察者间对病变分类的一致性较好（κ=0.81-0.88）。
DW-MRI 与 Gd-EOB-DTPA 增强 T1 加权 MRI 联合应用可显著提高结直肠肝转移的检出率。
