Semelka R C, Worawattanakul S, Kelekis N L, John G, Woosley J T, Graham M, Cance W G
Department of Radiology, University of North Carolina at Chapel Hill, USA.
J Magn Reson Imaging. 1997 Nov-Dec;7(6):1040-7. doi: 10.1002/jmri.1880070616.
This study compares liver lesion detection, characterization, and effect on patient management between single-phase spiral CT and MRI using spoiled gradient echo (SGE), T2-weighted fat-suppressed spin echo, and serial post gadolinium SGE. All patients with suspected liver lesions who underwent spiral CT and MRI within a 1-month period between January 1993 and September 1996 were included in the study. Spiral CT and MRI were interpreted prospectively in a blinded fashion by separate individual experienced investigators, and lesion detection and characterization were determined. Confirmation was obtained by surgery (6 patients), biopsy (18 patients), imaging follow-up (36 patients), or combined reading of all imaging studies and clinical follow-up (29 patients). Effect on patient management was determined by combined chart review and interview of the patients' physicians and by retrospective clinical assessment performed by a surgical oncologist and medical oncologist separately. Eighty-nine patients were included in the study. Regarding true positive lesion detection, 295 and 519 lesions were detected on spiral CT and MR images, respectively, which was significantly different on a patient-by-patient basis (P < .001). More lesions were detected on MR than on spiral CT in 44 of 89 patients (49.4%), and 11 of these 44 patients had lesions shown on MRI in whom no lesions were apparent on CT images. No patients had true positive lesions shown on spiral CT that were not shown on MRI. Regarding lesion characterization, 129 and 466 lesions were characterized on spiral CT and MRI images, respectively, which was significantly different on a patient-by-patient basis (P < .001). More lesions were characterized on MR than CT images in 67 patients (75.3%). Regarding effect on patient management, chart review with physician interview demonstrated that findings on MRI provided information that altered patient management as compared with findings on spiral CT in 57 patients. Retrospective clinical evaluation by the surgical and medical oncologist showed that MRI was considered to have a greater effect on patient management than spiral CT in 58 and 55 patients, respectively. Comparing current MRI technique to single-phase spiral CT, MRI detected more lesions in 49.4% and characterized more lesions in 75.3% of patients investigated for focal liver disease. MRI had a greater effect on patient management in each of the three methods than single-phase spiral CT in more than 61% of patients.
本研究比较了单相螺旋CT与MRI（使用扰相梯度回波序列[SGE]、T2加权脂肪抑制自旋回波序列以及钆剂增强后的连续SGE序列）在肝脏病变检测、特征描述以及对患者治疗管理的影响方面的差异。所有在1993年1月至1996年9月期间1个月内接受螺旋CT和MRI检查且怀疑有肝脏病变的患者均纳入本研究。螺旋CT和MRI由经验丰富的独立研究者以盲法进行前瞻性解读，并确定病变的检测与特征描述。通过手术（6例患者）、活检（18例患者）、影像随访（36例患者）或综合所有影像检查及临床随访结果（29例患者）来获得确诊。通过综合病历审查以及对患者医生的访谈，并由外科肿瘤学家和内科肿瘤学家分别进行回顾性临床评估来确定对患者治疗管理的影响。本研究共纳入89例患者。关于真阳性病变检测，螺旋CT和MR图像上分别检测到295个和519个病变，在逐个患者基础上有显著差异（P <.001）。89例患者中有44例（49.4%）在MR上检测到的病变多于螺旋CT，其中这44例患者中有11例在MRI上显示有病变而CT图像上未见明显病变。没有患者在螺旋CT上显示为真阳性病变而在MRI上未显示。关于病变特征描述，螺旋CT和MRI图像上分别对129个和466个病变进行了特征描述，在逐个患者基础上有显著差异（P <.001）。67例患者（75.3%）在MR上特征描述的病变多于CT图像。关于对患者治疗管理的影响，病历审查与医生访谈表明，与螺旋CT的检查结果相比，MRI的检查结果改变了57例患者的治疗管理。外科和内科肿瘤学家的回顾性临床评估显示，分别有58例和55例患者认为MRI对患者治疗管理的影响大于螺旋CT。将当前的MRI技术与单相螺旋CT进行比较，在因局灶性肝病接受检查的患者中，MRI在49.4%的患者中检测到更多病变，在75.3%的患者中对更多病变进行了特征描述。在超过61%的患者中，三种方法中的每一种，MRI对患者治疗管理的影响都大于单相螺旋CT。
