钆塞酸二钠肝胆期与细胞外对比剂延迟期图像对肝细胞癌显示的比较。
Comparison of hepatocellular carcinoma conspicuity on hepatobiliary phase images with gadoxetate disodium vs. delayed phase images with extracellular cellular contrast agent.
机构信息
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-ku, Seoul, 138-736, Korea.
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, No. 5, Fuxing St, Guishan Township, Taoyuan, Taoyuan County, 333, Taiwan.
出版信息
Abdom Radiol (NY). 2016 Aug;41(8):1522-31. doi: 10.1007/s00261-016-0703-1.
OBJECTIVE
To compare the conspicuity of hepatocellular carcinoma (HCC) on hepatobiliary phase of gadoxetate disodium-enhanced vs. delayed phase of gadodiamide-enhanced MR images, relative to liver function.
METHODS AND MATERIALS
We retrospectively identified 86 patients with newly diagnosed HCC between 2010 and 2013 and recorded the severity of liver disease by Child-Pugh class (CPC). 38 patients had gadodiamide-enhanced 5-min delayed and 48 had gadoxetate disodium-enhanced 20-min delayed hepatobiliary MR images. The conspicuity of 86 HCCs (mean size, 2.7 cm) was graded visually on a 3-point scale and quantified by liver-to-tumor contrast ratios (LTC). The relative liver parenchymal enhancement (RPE) was measured. For different CPCs, we compared the conspicuity of HCC and RPE between gadodiamide and gadoxetate.
RESULTS
In patients with CPC A, the visual conspicuity and LTC of the 27 HCCs imaged with gadodiamide were significantly lower than those of the 38 HCCs with gadoxetate (P < 0.01, <0.01, respectively). RPE was lower in gadodiamide scans than gadoxetate scans (P < 0.01). Conversely, in patients with CPC B and C, HCCs appeared more frequently as definite hypointensity when imaged with gadodiamide (72.7%, 8/11) than gadoxetate (20%, 2/10, P = 0.03). LTC (mean 18.1 vs. 7.5, P = 0.04) and RPE (mean 75.5 vs. 45.4, P = 0.04) was significantly higher in the gadodiamide than gadoxetate scans.
CONCLUSION
In patients with compromised liver function, hypointensity of HCC is more conspicuous in the gadodiamide delayed phase than the gadoxetate hepatobiliary phase. This likely reflects the high extracellular accumulation of gadodiamide and poor hepatocyte uptake of gadoxetate in patients with compromised liver function.
目的
比较钆塞酸二钠增强肝胆期与钆喷替酸葡甲胺增强延迟期 MRI 图像对肝细胞癌（HCC）的显示能力，同时评估其与肝功能的关系。
方法与材料
我们回顾性分析了 2010 年至 2013 年间 86 例新诊断为 HCC 的患者，并通过 Child-Pugh 分级（CPC）记录患者的肝功能严重程度。其中 38 例行钆喷替酸葡甲胺增强 5 分钟延迟扫描，48 例行钆塞酸二钠增强 20 分钟延迟扫描。使用 3 分制对 86 个 HCC（平均大小为 2.7cm）的显示程度进行了视觉分级，并通过肝脏与肿瘤对比率（LTC）进行了定量分析。同时测量了相对肝实质增强（RPE）。针对不同的 CPC，我们比较了两种造影剂增强扫描的 HCC 显示程度和 RPE。
结果
在 CPC A 的患者中，行钆喷替酸葡甲胺增强扫描的 27 个 HCC 的视觉显示程度和 LTC 明显低于行钆塞酸二钠增强扫描的 38 个 HCC（P<0.01，P<0.01）。钆喷替酸葡甲胺扫描的 RPE 低于钆塞酸二钠扫描（P<0.01）。相反，在 CPC B 和 C 的患者中，行钆喷替酸葡甲胺增强扫描时，更多的 HCC 表现为明确的低信号（72.7%，11 个中有 8 个），而钆塞酸二钠增强扫描时为低信号的比例为 20%（10 个中有 2 个，P=0.03）。钆喷替酸葡甲胺扫描的 LTC（平均 18.1 比 7.5，P=0.04）和 RPE（平均 75.5 比 45.4，P=0.04）明显高于钆塞酸二钠扫描。
结论
在肝功能受损的患者中，钆喷替酸葡甲胺增强延迟期 HCC 的低信号显示程度明显高于钆塞酸二钠增强肝胆期。这可能反映了在肝功能受损的患者中，钆喷替酸葡甲胺的细胞外聚集较高，而钆塞酸二钠的肝细胞摄取较差。
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