肝胆期钆塞酸增强 MRI 对高危患者肝细胞癌诊断的附加价值。
Added value of hepatobiliary phase gadoxetic acid-enhanced MRI for diagnosing hepatocellular carcinoma in high-risk patients.
机构信息
Sith Phongkitkarun, Kuruwin Limsamutpetch, Penampai Tannaphai, Janjira Jatchavala, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok 10400, Thailand.
出版信息
World J Gastroenterol. 2013 Dec 7;19(45):8357-65. doi: 10.3748/wjg.v19.i45.8357.
AIM
To determine the added value of hepatobiliary phase (HBP) gadoxetic acid-enhanced magnetic resonance imaging (MRI) in evaluating hepatic nodules in high-risk patients.
METHODS
The institutional review board approved this retrospective study and waived the requirement for informed consent. This study included 100 patients at high risk for hepatocellular carcinoma (HCC) and 105 hepatic nodules that were larger than 1 cm. A blind review of two MR image sets was performed in a random order: set 1, unenhanced (T1- and T2-weighted) and dynamic images; and set 2, unenhanced, dynamic 20-min and HBP images. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared for the two image sets. Univariate and multivariate analyses were performed on the MR characteristics utilized to diagnose HCC.
RESULTS
A total of 105 hepatic nodules were identified in 100 patients. Fifty-nine nodules were confirmed to be HCC. The diameter of the 59 HCCs ranged from 1 to 12 cm (mean: 1.9 cm). The remaining 46 nodules were benign (28 were of hepatocyte origin, nine were hepatic cysts, seven were hemangiomas, one was chronic inflammation, and one was focal fat infiltration). The diagnostic accuracy significantly increased with the addition of HBP images, from 88.7% in set 1 to 95.5% in set 2 (P = 0.002). In set 1 vs set 2, the sensitivity and NPV increased from 79.7% to 93.2% and from 78.9% to 91.8%, respectively, whereas the specificity and PPV were not significantly different. The hypointensity on the HBP images was the most sensitive (93.2%), and typical arterial enhancement followed by washout was the most specific (97.8%). The multivariate analysis revealed that typical arterial enhancement followed by washout, hyperintensity on T2-weighted images, and hypointensity on HBP images were statistically significant MRI findings that could diagnose HCC (P < 0.05).
CONCLUSION
The addition of HBP gadoxetic acid-enhanced MRI statistically improved the diagnostic accuracy in HCCs larger than 1 cm. Typical arterial enhancement followed by washout and hypointensity on HBP images are useful for diagnosing HCC.
目的
确定肝胆期（HBP）钆塞酸增强磁共振成像（MRI）在评估高危患者肝脏结节中的附加价值。
方法
本回顾性研究经机构审查委员会批准，并豁免了知情同意书的要求。该研究纳入了 100 例肝癌（HCC）高危患者和 105 个大于 1cm 的肝脏结节。对两组 MRI 图像进行随机盲法评估：组 1，未增强（T1 加权和 T2 加权）和动态图像；组 2，未增强，动态 20 分钟和 HBP 图像。比较两组图像的诊断准确性、敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。对用于诊断 HCC 的 MR 特征进行单因素和多因素分析。
结果
共在 100 例患者中发现 105 个肝脏结节。其中 59 个结节被证实为 HCC。59 个 HCC 的直径为 1~12cm（平均 1.9cm）。其余 46 个结节为良性（28 个为肝细胞来源，9 个为肝囊肿，7 个为血管瘤，1 个为慢性炎症，1 个为局限性脂肪浸润）。随着 HBP 图像的加入，诊断准确性显著提高，从组 1 的 88.7%提高到组 2 的 95.5%（P=0.002）。与组 1 相比，组 2 的敏感度和 NPV 分别从 79.7%提高到 93.2%和从 78.9%提高到 91.8%，而特异度和 PPV无显著差异。HBP 图像上的低信号最敏感（93.2%），典型的动脉期增强后廓清最特异（97.8%）。多因素分析显示，典型的动脉期增强后廓清、T2 加权像上的高信号和 HBP 图像上的低信号是诊断 HCC 的有统计学意义的 MRI 表现（P<0.05）。
结论
在直径大于 1cm 的 HCC 中，添加 HBP 钆塞酸增强 MRI 可显著提高诊断准确性。典型的动脉期增强后廓清和 HBP 图像上的低信号有助于诊断 HCC。
Zotero 插件