Gd-EOB-DTPA动态增强MRI与64排增强CT评估乙型肝炎肝硬化背景小肝癌病灶的差异

摘要/Abstract

摘要： 目的比较钆塞酸二钠增强磁共振(Gd-EOB-DTPA-MRI)和64排螺旋CT(64-MDCT)对小肝癌(SHCC)病灶诊断表现分析。方法 2018年3月至2020年5月经Gd-EOB-DTPA-MRI、64-MDCT检查SHCC患者60例(男性43例、女性17例),年龄(53.3±10.4)岁。纳入标准:术后诊断为HCC(手术切除、超声下引导穿刺活检)且病灶直径≤2 cm;接受Gd-EOB-DTPA-MRI和64-MDCT检查,检查间隔<4周;非转移性肝癌或伴有其他恶性肿瘤。典型SHCC病灶MDCT或Gd-EOB-DTPA-MRI表现为动脉期病灶高强化,门静脉或延迟期强化迅速下降。数据采用卡方检验,绘制ROC曲线,计算曲线下面积(AUC)、敏感度、特异度。结果 60例SHCC患者病灶74个(手术切除26个、超声下引导穿刺活检48个)。64-MDCT动脉期时SHCC病灶高增强68个(91.9%)、等增强6个(8.1%)、低增强0(0),Gd-EOB-DTPA-MRI肝胆期时SHCC病灶高增强1个(1.4%)、等增强4个(5.4%)、低增强69个(93.2%)。诊断SHCC病灶时,64-MDCT敏感度、特异度为79.5%、91.4%;Gd-EOB-DTPA-MRI敏感度、特异度为81.6%、82.0%;64-MDCT联合Gd-EOB-DTPA-MRI敏感度、特异度为67.8%、100%;64-MDCT动脉期联合Gd-EOB-DTPA-MRI肝胆期敏感度、特异度为94.2%、93.0%。64-MDCT动脉期联合Gd-EOB-DTPA-MRI肝胆期(0.92)AUC值分别显著高于64-MDCT(0.84,P<0.05)、Gd-EOB-DTPA-MRI(0.81,P<0.05)及64-MDCT联合 Gd-EOB-DTPA-MRI(0.85,P<0.05)。结论 64-MDCT动脉期联合Gd-EOB-DTPA-MRI肝胆期对SHCC病灶诊断具有较高的敏感度及特异度,有助于SHCC的诊断。

关键词: 小肝癌, 钆塞酸二钠增强磁共振, ROC曲线

Abstract: Objective To comparatively analyze the difference of Gd-EOB-DTPA enhanced Magnetic Resonance Imaging (MRI) (Gd-EOB-DTPA-MRI) and 64-row spiral Computed Tomography (64-MDCT) in evaluating small hepatocellular carcinoma (SHCC).Methods Sixty patients including 43 males and 17 females with SHCC were examined by Gd-EOB-DTPA-MRI and 64-MDCT. The inclusive criteria are: preoperative diagnosis of HCC by surgical resection or ultrasound-guided biopsy; lesion diameter ≤2 cm; Gd-EOB-DTPA-MRI and 64-MDCT examination within 4 weeks; without metastatic liver cancer or other malignant tumors. MDCT or Gd-EOB-DTPA-MRI of typical SHCC lesions showed high enhancement of blood vessels at arterial phase and a rapid decrease in density at portal vein and delayed phases. Chi-square test was used for statistical analysis. Receiver operating characteristic curve(ROC)and the area under the curve (AUC) were drawn and the sensitivity and specificity under the curve were calculated.Results Seventy-four lesions were found in 60 SHCC patients (26 lesions were excised surgically and 48 lesions were biopsied under ultrasound guidance). In 64-MDCT arterial phase, there were 68 SHCC lesions with high enhancement (91.9%), 6 with equal enhancement (8.1%), 0 with low enhancement (0). In Gd-EOB-DTPA-MRI hepatobiliary phase, there were 1 lesion with high enhancement (1.4%), 4 with equal enhancement (5.4%) and 69 with low enhancement (93.2%). The sensitivity and specificity of 64-MDCT for diagnosing SHCC,were 79.5% and 91.4%, respectively. The sensitivity and specificity of Gd-EOB-DTPA-MRI were 81.6% and 82.0%. The sensitivity and specificity of 64-MDCT combined with Gd-EOB-DTPA-MRI were 67.8% and 100%. The sensitivity and specificity of 64-MDCT in arterial phase combined with Gd-EOB-DTPA-MRI in hepatobiliary phase were 94.2% and 93.0%, respectively. The AUC values of 64-MDCT in arterial phase combined with Gd-EOB-DTPA-MRI in hepatobiliary phase (0.92) were significantly higher than those of 64-MDCT (0.84, P<0.05), Gd-EOB-DTPA-MRI (0.81, P<0.05), and 64-MDCT combined with Gd-EOB-DTPA-MRI (0.85, P<0.05).Conclusion 64-MDCT in arterial phase combined with Gd-EOB-DTPA-MRI in hepatobiliary phase has higher sensitivity and specificity in identifying SHCC lesions, which is helpful for the diagnosis of SHCC.

Key words: Small hepatocellular carcinoma, Gd-EOB-DTPA enhanced Magnetic Resonance Imaging, 64-row spiral Computed Tomography, diagnosis

刘敏, 张进, 陆玉. Gd-EOB-DTPA动态增强MRI与64排增强CT评估乙型肝炎肝硬化背景小肝癌病灶的差异[J]. 肝脏, 2020, 25(12): 1278-1281.

LIU Min, ZHANG Jin, LU Yu. Gd-EOB-DTPA dynamic contrast-enhanced magnetic resonance imaging and 64-row contrast-enhanced computed tomography for evaluating small hepatocellular carcinoma on the background of hepatitis B-related cirrhosis[J]. Chinese Hepatolgy, 2020, 25(12): 1278-1281.

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