Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy.
Quant Imaging Med Surg. 2014 Jun;4(3):181-9. doi: 10.3978/j.issn.2223-4292.2014.01.02.
To compare the diagnostic value of gadolinium (Gd) and ultrasmall superparamagnetic iron oxide (SPIO) contrast media for characterization of focal liver lesions (FLL), we retrospectively evaluated the results of magnetic resonance (MR) imaging in 68 patients (40 M, 28 F, age from 22 to 81 yrs) of which 36 with diagnosis of colo-rectal cancer, 26 with hepatic cirrhosis and 6 with incidental imaging detection of FLL. MR (Gyroscan Intera 1.5 T, Philips Medical Systems) study was performed using T1 and T2 fast-field-echo (FFE) and T2 turbo-spin-echo (TSE) sequences in axial and coronal views. Dynamic multi-phases gadolinium Gd-enhanced T1-FFE-Bh images were obtained in arterial, portal and equilibrium phases, followed by SPIO-enhanced T2-FFE scans. A qualitative analysis of pre- and post-contrast MR images to classify FLL as benign or malignant was performed using a 3-point scoring system: 0= benign; 1= suspicious for malignancy; 2= malignant. A total of 118 lesions were evaluated. In particular, histology (n=18), cytology (n=14) or clinical-imaging follow-up data (n=86) demonstrated 4 adenomas, 29 cysts, 3 focal steatosis, 25 hemangiomas, 1 focal vascular abnormality, 5 fibrotic lesions as well as 13 regenerative nodules, 6 dysplastic, 14 hepatocellular carcinomas (HCC), 17 metastasis and 1 cholangiocarcinoma. For MR imaging, diagnostic accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of Gd vs. SPIO images were respectively 83% vs. 92%, 79% vs. 74%, 85% vs. 99% (P=0.002), 68% vs. 96% (P=0.005) and 91% vs. 90%, respectively. The results suggest that SPIO-MR provides a diagnostic incremental value, as specificity and PPV, particularly to characterize FLL compared to Gd-MR; thus, we strongly recommend the use of SPIO when liver lesion characterization is requested and Gd images are uncertain.
为了比较钆（Gd）和超顺磁性氧化铁（SPIO）对比剂在局灶性肝病变（FLL）特征描述中的诊断价值，我们对 68 例患者（40 例男性，28 例女性；年龄 22-81 岁）的磁共振（MR）成像结果进行了回顾性评估，其中 36 例患者诊断为结直肠癌，26 例患者患有肝硬化，6 例患者为偶然发现的 FLL。MR（Gyroscan Intera 1.5T，Philips Medical Systems）研究采用 T1 和 T2 快速场回波（FFE）以及 T2 涡轮自旋回波（TSE）序列进行轴向和冠状视图。在动脉期、门脉期和平衡期获得动态多相 Gd 增强 T1-FFE-Bh 图像，随后进行 SPIO 增强 T2-FFE 扫描。使用 3 分评分系统对增强前后的 MR 图像进行定性分析，将 FLL 分类为良性或恶性：0=良性；1=疑似恶性；2=恶性。共评估了 118 个病变。具体而言，组织学（n=18）、细胞学（n=14）或临床影像学随访数据（n=86）显示 4 个腺瘤、29 个囊肿、3 个局灶性脂肪变性、25 个血管瘤、1 个局灶性血管异常、5 个纤维性病变以及 13 个再生性结节、6 个发育不良、14 个肝细胞癌（HCC）、17 个转移瘤和 1 个胆管癌。对于 MR 成像，Gd 与 SPIO 图像的诊断准确性、敏感性、特异性、阳性（PPV）和阴性（NPV）预测值分别为 83%与 92%、79%与 74%、85%与 99%（P=0.002）、68%与 96%（P=0.005）和 91%与 90%。结果表明，SPIO-MR 提供了诊断附加值，尤其是在与 Gd-MR 相比时，特异性和 PPV 特别有助于描述 FLL；因此，当需要对肝病变进行特征描述且 Gd 图像不确定时，我们强烈建议使用 SPIO。
