肝细胞癌的影像学特征：钆塞酸二钠（Gd-EOB-DTPA）增强 MRI 与 Gd-DTPA 的定量和定性比较
Imaging Features of Hepatocellular Carcinoma: Quantitative and Qualitative Comparison Between MRI-Enhanced With Gd-EOB-DTPA and Gd-DTPA.
机构信息
Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang.
Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea.
出版信息
Invest Radiol. 2019 Aug;54(8):494-499. doi: 10.1097/RLI.0000000000000562.
OBJECTIVES
The aim of this study was to compare the major imaging features of hepatocellular carcinoma (HCC) on magnetic resonance imaging (MRI) scans with Gd-EOB-DTPA (EOB) and extracellular agent (ECA; Gd-DTPA) contrast media.
MATERIALS AND METHODS
Among 184 surgically proven HCCs in 169 patients who underwent a liver MRI with either EOB (n = 120) or ECA (n = 49), 55 HCCs were matched according to tumor size, Edmonson grade (major and worst), and gross type for each of the 2 contrast media. For the qualitative analysis, 2 board-certified radiologists independently reviewed arterial phase hyperenhancement, hypointensity on portal venous phase, hypointensity on delayed or transitional phase (DP/TP, 120-150 seconds), and capsule appearance. For the quantitative analysis, a third radiologist measured the signal intensity at each phase by placing the region of interest for tumor and normal liver parenchyma. The lesion-to-liver contrast (LLC) and lesion-to-liver contrast enhancement ratio (LLCER) were calculated.
RESULTS
On qualitative analysis, hypointensity on DP/TP was seen more frequently with EOB (91% in reader 1, 89% in reader 2) than with ECA (73% in reader 1, 75% in reader 2; P = 0.026). Capsule appearance was seen less frequently with EOB (31% in reader 1, 44% in reader 2) than with ECA (73% in reader 1, 78% in reader 2; P < 0.001). On quantitative analysis, the LLC on arterial phase (AP) was better with ECA (P = 0.003), whereas LLC on DP was better with EOB (P < 0.001). The LLCER from precontrast to AP was higher with ECA (P = 0.022), whereas the LLCER from portal venous phase to DP was higher with EOB (P < 0.001).
CONCLUSIONS
ECA-MRI revealed better LLC on AP and detection rate of capsule appearance than EOB-MRI. EOB-MRI showed superior LLC on TP.
目的
本研究旨在比较肝细胞癌（HCC）在磁共振成像（MRI）扫描中使用钆-EOB-DTPA（EOB）和细胞外造影剂（ECA；Gd-DTPA）造影剂的主要影像学特征。
材料与方法
在 169 名接受肝脏 MRI 检查的患者中，共有 184 例经手术证实的 HCC，其中 120 例接受 EOB 检查，49 例接受 ECA 检查。根据肿瘤大小、Edmonson 分级（主要和最差）和两种造影剂的大体类型，对 55 例 HCC 进行了匹配。对于定性分析，两位具有董事会认证的放射科医生独立评估动脉期强化、门静脉期低信号、延迟或过渡期（DP/TP，120-150 秒）低信号和包膜外观。对于定量分析，第三位放射科医生通过在感兴趣区域放置肿瘤和正常肝实质来测量每个阶段的信号强度。计算病变-肝对比（LLC）和病变-肝增强比（LLCER）。
结果
在定性分析中，EOB（读者 1 中为 91%，读者 2 中为 89%）在 DP/TP 期的低信号强度比 ECA（读者 1 中为 73%，读者 2 中为 75%）更常见（P = 0.026）。EOB 比 ECA （读者 1 中为 31%，读者 2 中为 44%）更少见包膜外观（P < 0.001）。在定量分析中，ECA 在动脉期（AP）的 LLC 更好（P = 0.003），而 EOB 在 DP 的 LLC 更好（P < 0.001）。从对比前到 AP 的 LLCER 用 ECA 更高（P = 0.022），而从门静脉期到 DP 的 LLCER 用 EOB 更高（P < 0.001）。
结论
与 EOB-MRI 相比，ECA-MRI 在 AP 显示更好的 LLC 和包膜外观检测率。EOB-MRI 在 TP 显示更好的 LLC。
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