Section of Abdominal Imaging, The Cleveland Clinic Foundation, Cleveland Clinic Main Campus, 9500 Euclid Ave, A21, Cleveland, OH 44195, USA.
AJR Am J Roentgenol. 2012 Jan;198(1):115-23. doi: 10.2214/AJR.11.6836.
The purpose of this study is to evaluate the performance of gadoxetate disodium-enhanced MRI in the characterization of focal nodular hyperplasia (FNH) and hepatocellular adenoma and to assess potential advantages of hepatocyte phase imaging in identifying features that distinguish FNH from hepatocellular adenoma.
Gadoxetate disodium-enhanced MRI examinations of 12 patients with hepatocellular adenoma and 35 patients with FNH were retrospectively evaluated by three blinded readers. Diagnoses and confidence scores were recorded before and after disclosure of hepatocyte phase images. The data obtained were combined to create receiver operating characteristic curves, and the areas under the curves were compared. Imaging characteristics, including signal intensity, were recorded. Lesion-to-liver enhancement ratio was calculated for each contrast-enhanced phase.
The readers' average receiver operating characteristic area was significantly higher after disclosure of hepatocyte phase images (p=0.024). FNHs were correctly diagnosed in 74.3-97.1% of cases before and 97.1-100% of cases after the disclosure of hepatocyte phase images; hepatocellular adenoma was correctly diagnosed in 83-100% and 91.7-100% of cases (p>0.05). The presence of a central scar in FNH and fat on hepatocellular adenoma were the only morphologic features that were statistically significantly different (p<0.05). FNH had greater average contrast-enhanced signal intensity and enhancement ratio in all phases (p<0.001). A hepatocyte phase enhancement ratio of less than 0.7 was 100% specific and 91.6% sensitive for hepatocellular adenoma, with accuracy of 97.1% for these data.
Gadoxetate disodium-enhanced MRI had high accuracy in diagnosis of FNH and hepatocellular adenoma, and the hepatocyte phase improved their distinction. FNH enhances significantly more than hepatocellular adenoma. An enhancement ratio, particularly in the hepatocyte phase, can be potentially used as an additional distinguishing feature.
本研究旨在评估钆塞酸二钠增强 MRI 对局灶性结节增生（FNH）和肝细胞腺瘤的特征表现，并评估肝细胞期成像在识别 FNH 与肝细胞腺瘤之间特征方面的潜在优势。
回顾性分析了 12 例肝细胞腺瘤和 35 例 FNH 患者的钆塞酸二钠增强 MRI 检查结果，由 3 名盲法读者进行评估。在显示肝细胞期图像前后记录诊断和置信度评分。将获得的数据合并以创建受试者工作特征曲线，并比较曲线下面积。记录病灶的信号强度等影像学特征。计算各增强期的病灶与肝脏的强化比值。
显示肝细胞期图像后，读者的平均受试者工作特征曲线下面积显著提高（p=0.024）。FNH 在显示肝细胞期图像前后的正确诊断率分别为 74.3%-97.1%和 97.1%-100%；肝细胞腺瘤的正确诊断率分别为 83%-100%和 91.7%-100%（p>0.05）。FNH 存在中央瘢痕，肝细胞腺瘤存在脂肪是唯一具有统计学差异的形态学特征（p<0.05）。FNH 在各期的平均增强信号强度和增强比值均较大（p<0.001）。肝细胞期强化比值<0.7 对肝细胞腺瘤具有 100%的特异性和 91.6%的敏感性，这些数据的准确率为 97.1%。
钆塞酸二钠增强 MRI 对 FNH 和肝细胞腺瘤的诊断具有较高的准确性，且肝细胞期有助于二者的鉴别。FNH 的强化程度明显高于肝细胞腺瘤。强化比值，特别是在肝细胞期，可能作为一种额外的鉴别特征。
