患者内比较 Gd-BOPTA 和 Gd-EOB-DTPA 的肝胆期在肝细胞腺瘤与局灶性结节增生鉴别诊断中的作用。

Intrapatient Comparison of the Hepatobiliary Phase of Gd-BOPTA and Gd-EOB-DTPA in the Differentiation of Hepatocellular Adenoma From Focal Nodular Hyperplasia.

机构信息

Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Department of Radiology, Peter MacCallum Cancer Centre Melbourne, Australia.

出版信息

J Magn Reson Imaging. 2019 Mar;49(3):700-710. doi: 10.1002/jmri.26227. Epub 2018 Sep 25.

DOI:10.1002/jmri.26227

PMID:30252977

Abstract

BACKGROUND

Current imaging guidelines do not specify the preferred hepatobiliary contrast agent when differentiating hepatocellular adenoma (HCA) from focal nodular hyperplasia (FNH) on MRI.

PURPOSE

To analyze intrapatient differences in the hepatobiliary phase (HBP) after use of both gadobenate dimeglumine (Gd-BOPTA) and gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI to differentiate HCA from FNH.

STUDY TYPE

Retrospective.

POPULATION

Patients who underwent both Gd-BOPTA and Gd-EOB-DTPA-enhanced MRI, including 33 patients with 82 lesions (67 HCA; 15 FNH), with a step-down reference standard of pathology, 20% regression, identical appearance to earlier biopsied lesions, and stringent imaging findings.

FIELD STRENGTH/SEQUENCE: 1.5T and 3T HBP of Gd-BOPTA and Gd-EOB-DTPA-enhanced MRI, precontrast fat-suppressed T -weighted sequence.

ASSESSMENT

Signal intensities relative to the surrounding liver in the HBP were assessed by two observers.

STATISTICAL TESTS

Sensitivity and specificity of HCA diagnosis were calculated for both contrast agents. Interobserver agreement was evaluated using Cohen's kappa; differences in degree of certainty for scoring a lesion were calculated by means of the Wilcoxon signed rank test. Differences in signal intensity between Gd-BOPTA and Gd-EOB-DTPA were calculated using McNemar's test.

RESULTS

Almost perfect agreement was found between observers for scored signal intensities with both contrast agents. In 30 of the 82 lesions (37%) a difference was observed between contrast agents in the HBP, with Gd-EOB-DTPA proving correct in all but one of the discordant lesions. When distinguishing HCA from FNH, Gd-BOPTA showed a sensitivity of 46% (31/67) and a specificity of 87% (13/15), while the sensitivity and specificity of Gd-EOB-DTPA was 85% (57/67) and 100% (15/15), respectively. A risk of misclassifying HCA as FNH typically occurs for Gd-BOPTA when lesions are intrinsically hyperintense (P < 0.005).

DATA CONCLUSION

The HBP of Gd-EOB-DTPA shows superior accuracy in ruling out HCA in comparison with Gd-BOPTA, especially when the lesion is intrinsically hyperintense on T -weighted imaging.

LEVEL OF EVIDENCE

3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:700-710.

摘要

背景

在 MRI 上鉴别肝细胞腺瘤（HCA）和局灶性结节增生（FNH）时，目前的影像学指南并未明确推荐首选的肝胆对比剂。

目的

分析钆贝葡胺（Gd-BOPTA）和钆塞酸二钠（Gd-EOB-DTPA）增强 MRI 后肝胆期（HBP）在鉴别 HCA 和 FNH 中的患者内差异。

研究类型

回顾性。

人群

接受 Gd-BOPTA 和 Gd-EOB-DTPA 增强 MRI 的患者，包括 33 例患者的 82 个病灶（67 个 HCA；15 个 FNH），以病理为降级参考标准，20%的病变有消退，与先前活检的病变外观相同，且影像学表现严格。

磁场强度/序列：1.5T 和 3T 的 Gd-BOPTA 和 Gd-EOB-DTPA 增强 MRI，以及预对比脂肪抑制 T1 加权序列。

评估

两名观察者评估 HBP 中相对于周围肝脏的信号强度。

统计学检验

计算两种对比剂诊断 HCA 的敏感度和特异度。采用 Cohen's kappa 评估观察者间一致性；通过 Wilcoxon 符号秩检验计算评分病变的置信度差异。采用 McNemar 检验计算 Gd-BOPTA 和 Gd-EOB-DTPA 之间的信号强度差异。

结果

两种对比剂的观察者间评分信号强度具有近乎完美的一致性。在 82 个病灶中的 30 个（37%）病灶中，HBP 中观察到两种对比剂之间存在差异，Gd-EOB-DTPA 在所有不一致的病灶中除了 1 个病灶外均正确。在鉴别 HCA 和 FNH 时，Gd-BOPTA 的敏感度为 46%（31/67），特异度为 87%（13/15），而 Gd-EOB-DTPA 的敏感度和特异度分别为 85%（57/67）和 100%（15/15）。当病灶在 T1 加权成像上固有高信号时，Gd-BOPTA 将 HCA 误诊为 FNH 的风险通常较高（P < 0.005）。