Department of Radiology, University Medical Center Regensburg, Regensburg 93042, Germany.
BMC Med Imaging. 2013 Dec 1;13:41. doi: 10.1186/1471-2342-13-41.
Correct characterization of focal solid hepatic lesions has always been a challenge and is of great diagnostic and therapeutic relevance. The purpose of this study was to determine the added value of hepatobiliary phase images in Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for differentiating focal solid hepatic lesions.
In this retrospective trial 84 consecutive patients underwent Gd-EOB-DTPA-enhanced MR examinations. MRI was conducted for 64 patients with malignant focal hepatic lesions (34 hepatocellular carcinoma (HCC), 30 metastases) and for 20 patients with benign hepatic lesions (14 focal nodular hyperplasia (FNH), 3 adenoma, 3 hemangioma). Five radiologists independently reviewed three sets of MR images by means of a 5-point confidence scale from score 1 (definitely benign) to score 5 (definitely malignant): set 1: unenhanced images; set 2: unenhanced and Gd-EOB-DTPA-enhanced dynamic images; set 3: hepatobiliary phase images in addition to set 2. Accuracy was assessed by the alternative free-response receiver operating characteristic curve (Az) and the index of diagnostic performance was calculated.
Diagnostic accuracy was significantly improved by the addition of Gd-EOB-DTPA-enhanced dynamic images: Az in set 1 was 0.708 and 0.833 in set 2 (P = 0.0002). The addition of hepatobiliary phase images increased the Az value to 0.941 in set 3 (set 3 vs set 2, P < 0.0001; set 3 vs set 1, P < 0.0001). The index of diagnostic performance was lowest in set 1 (45%), improved in set 2 (71%), and highest in set 3 (94%).
Hepatobiliary phase images obtained after Gd-EOB-DTPA-enhanced dynamic MRI improve the differentiation of focal solid hepatic lesions.
准确描述局灶性肝脏实性病变一直是一个挑战，对诊断和治疗具有重要意义。本研究旨在确定钆塞酸二钠增强磁共振成像（MRI）肝胆期成像在鉴别局灶性肝脏实性病变中的附加价值。
本回顾性试验纳入 84 例连续患者行 Gd-EOB-DTPA 增强 MRI 检查。对 64 例恶性局灶性肝脏病变（34 例肝细胞癌（HCC），30 例转移瘤）和 20 例良性肝脏病变（14 例局灶性结节增生（FNH），3 例腺瘤，3 例血管瘤）患者进行 MRI 检查。5 名放射科医生通过 5 分置信度评分（评分 1 表示“肯定良性”，评分 5 表示“肯定恶性”）独立评估三组 MRI 图像：第 1 组：平扫图像；第 2 组：平扫+钆塞酸二钠增强动态图像；第 3 组：第 2 组+肝胆期图像。采用备选自由反应接受者操作特征曲线（Az）评估准确性，并计算诊断性能指标。
加入钆塞酸二钠增强动态图像后，诊断准确性显著提高：第 1 组 Az 为 0.708，第 2 组 Az 为 0.833（P=0.0002）。加入肝胆期图像后，第 3 组 Az 值增加至 0.941（第 3 组与第 2 组相比，P<0.0001；第 3 组与第 1 组相比，P<0.0001）。第 1 组诊断性能指标最低（45%），第 2 组（71%）提高，第 3 组最高（94%）。
钆塞酸二钠增强动态 MRI 后获得的肝胆期图像可改善局灶性肝脏实性病变的鉴别。
