Kanematsu M, Hoshi H, Murakami T, Inaba Y, Kim T, Yamada T, Kato M, Yokoyama R, Nakamura H
Department of Radiology, Gifu University School of Medicine, Japan.
AJR Am J Roentgenol. 1997 Dec;169(6):1507-15. doi: 10.2214/ajr.169.6.9393154.
The purpose of our study was to compare the combination of conventional spin-echo, phase-shift gradient-recalled echo (GRE), and triple-phasic dynamic GRE MR imaging with the combination of helical CT hepatic arteriography (CTA) and CT performed during arterial portography (CTAP) in the preoperative detection of hepatocellular carcinoma (HCC).
Thirty-seven patients with cirrhosis underwent MR imaging and angiographically assisted CT imaging. Paired T1- and T2-weighted spin-echo images, paired in-phase and out-of-phase GRE images, triple-phasic dynamic GRE images, the combined MR images, and the paired CTA and CTAP images were retrospectively and independently reviewed by three radiologists. Image review was done on a segment-by-segment basis. Of the 280 liver segments, 58 segments contained 79 HCCs that were 0.5-8.0 cm (mean, 2.0 cm) in diameter. The diagnostic value of each pair of images was rated by means of receiver operating characteristic curve analysis.
The diagnostic accuracy of combined CTA and CTAP (mean area under the receiver operating characteristic curve [Az] = 0.94) was significantly better than that of spin-echo (Az = 0.86, p < .0001), phase-shift GRE (Az = 0.83, p < .0001), dynamic GRE (Az = 0.85, p < .0001), and all combined (Az = 0.91, p < .001) MR imaging. The relative sensitivity of combined CTA and CTAP (89%) was also significantly (p < .0005) better than that of the combined MR imaging (75%).
Angiographically assisted helical CT imaging was superior to MR imaging combined with conventional spin-echo, phase-shift GRE, and triple-phasic dynamic GRE techniques in the detection of HCC in patients with cirrhosis. The noninvasive dedicated combined MR imaging could not obviate invasive angiographically assisted CT imaging. Combined CTA and CTAP is recommended, especially in the preoperative examination of patients with HCC.
本研究旨在比较传统自旋回波、相移梯度回波（GRE）和三相动态GRE磁共振成像联合检查与螺旋CT肝动脉造影（CTA）和动脉门静脉造影（CTAP）期间进行的CT联合检查在肝细胞癌（HCC）术前检测中的效果。
37例肝硬化患者接受了磁共振成像和血管造影辅助CT成像检查。三位放射科医生对配对的T1加权和T2加权自旋回波图像、同相位和反相位GRE图像、三相动态GRE图像、联合磁共振图像以及配对的CTA和CTAP图像进行了回顾性独立评估。图像评估逐段进行。在280个肝段中，58个肝段含有79个直径为0.5 - 8.0 cm（平均2.0 cm）的HCC。通过接受者操作特征曲线分析对每对图像的诊断价值进行评分。
联合CTA和CTAP的诊断准确性（接受者操作特征曲线下平均面积[Az] = 0.94）显著优于自旋回波（Az = 0.86，p <.0001）、相移GRE（Az = 0.83，p <.0001）、动态GRE（Az = 0.85，p <.0001）以及所有联合（Az = 0.91，p <.001）磁共振成像。联合CTA和CTAP的相对敏感性（89%）也显著（p <.0005）高于联合磁共振成像（75%）。
在肝硬化患者HCC检测中，血管造影辅助螺旋CT成像优于传统自旋回波、相移GRE和三相动态GRE技术联合的磁共振成像。无创的专用联合磁共振成像不能取代有创的血管造影辅助CT成像。推荐联合CTA和CTAP，尤其是在HCC患者的术前检查中。
