Atman Ebru Düşünceli, Erden Ayşe, Uzun Çağlar, Yavuz Yasemin
From the Departments of *Radiology and †Biostatistics, Ankara University School of Medicine, Ankara, Turkey.
J Comput Assist Tomogr. 2015 Jul-Aug;39(4):483-8. doi: 10.1097/RCT.0000000000000257.
The aim of this study was to evaluate the additional diagnostic value of "inversion recovery" single-shot fast-spin echo (IR-SSFSE) sequence using the inversion time at the null point for hepatic hemangiomas as a supplement to standard T2-weighted (T2W) magnetic resonance imaging for the distinction of hemangiomas and cysts.
A total of 228 lesions in 56 patients were evaluated in this retrospective study. In addition to routine hepatic magnetic resonance imaging, IR-SSFSE imaging using inversion time value of 600 milliseconds (null point for hepatic hemangiomas) was obtained. Two radiologists independently reviewed T2W images at first and T2W images plus IR-SSFSE sequence 4 weeks afterward and used a 5-point scale to indicate the possibility of detected hyperintense lesion is a cyst or a hemangioma. A receiver operating characteristic analysis and κ statistics were used to evaluate the diagnostic additive value of IR-SSFSE sequence for differentiation of hepatic hemangiomas and cysts, and to determine interobserver agreement, respectively.
Among 228 lesions, diameters of which ranges from 2 to 125 mm (mean, 13.84 ± 16.24 mm), 56.14% of them (n = 128) were hemangiomas, and 43.86% of them were cysts (n = 100). In the receiver operating characteristic analysis for the differentiation of hepatic hemangiomas from cysts, the calculated area under the curve (AUC) for standard T2W images alone was 0.889 (95% confidence interval [CI], 0.825-0.953) for the first observer and 0.913 (95% CI, 0.861-0.965) for the second observer. When IR-SSFSE sequence was combined to T2W images, AUC was calculated as 0.958 (95% CI, 0.920-0.996) for the first observer and 0.980 (95% CI, 0.956-1.0) for the second observer. The AUC values obtained from standard T2W images and standard T2W plus IR-SSFSE images were significantly different for both observers (P < 0.01). Both observers demonstrate better performance in differentiating hemangiomas and cysts with a combination of IR-SSFSE sequence and T2W imaging than with T2W imaging alone. Adding IR-SSFSE sequence as a supplement to standard T2W images improved the sensitivity and the κ values.
Inversion recovery single-shot fast-spin echo sequence using the inversion time to null signal from the hepatic hemangiomas as a supplement to standard T2W images is useful for distinguishing hemangiomas from hepatic cysts without the need for intravenous gadolinium chelate administration.
本研究旨在评估利用零点反转时间的“反转恢复”单次激发快速自旋回波（IR-SSFSE）序列对肝血管瘤的额外诊断价值，作为标准T2加权（T2W）磁共振成像的补充，以鉴别血管瘤和囊肿。
本回顾性研究共评估了56例患者的228个病灶。除常规肝脏磁共振成像外，还获得了使用600毫秒反转时间值（肝血管瘤的零点）的IR-SSFSE成像。两名放射科医生首先独立审查T2W图像，4周后审查T2W图像加IR-SSFSE序列，并使用5分制来表明检测到的高信号病灶是囊肿或血管瘤的可能性。分别采用受试者工作特征分析和κ统计来评估IR-SSFSE序列对肝血管瘤和囊肿鉴别的诊断附加值，并确定观察者间的一致性。
在228个病灶中，直径范围为2至125毫米（平均为13.84±16.24毫米），其中56.14%（n = 128）为血管瘤，43.86%为囊肿（n = 100）。在肝血管瘤与囊肿鉴别的受试者工作特征分析中，第一位观察者单独使用标准T2W图像计算的曲线下面积（AUC）为0.889（95%置信区间[CI]，0.825 - 0.953），第二位观察者为0.913（95%CI，0.861 - 0.965）。当IR-SSFSE序列与T2W图像联合使用时，第一位观察者计算的AUC为0.958（95%CI，0.920 - 0.996），第二位观察者为0.980（95%CI，0.956 - 1.0）。两位观察者从标准T2W图像和标准T2W加IR-SSFSE图像获得的AUC值均有显著差异（P < 0.01）。与单独使用T2W成像相比，两位观察者在联合使用IR-SSFSE序列和T2W成像鉴别血管瘤和囊肿方面表现更好。添加IR-SSFSE序列作为标准T2W图像的补充提高了敏感性和κ值。
利用肝血管瘤零信号反转时间的反转恢复单次激发快速自旋回波序列作为标准T2W图像的补充，无需静脉注射钆螯合物即可有效鉴别肝血管瘤和肝囊肿。
