钆双胺增强MRI及CT增强诊断肝功能Child-Pugh A级肝细胞癌的价值分析

摘要/Abstract

摘要： 目的探讨钆双胺增强磁共振成像(MRI)和计算机体层成像(CT)增强诊断肝功能Child-Pugh A级肝细胞癌(HCC)的临床价值。方法纳入2018年12月至2020年12月铁岭市中心医院收治的肝功能Child-Pugh A级HCC患者114例,所有患者均行钆双胺增强MRI和CT增强扫描,比较2种影像学检查方法HCC结节检出率、强化方式及包膜检出率。结果 114例患者均经手术病理检查确诊,共发现150个HCC结节。钆双胺增强MRI检出HCC结节的敏感度为94.67%(142/150),高于增强CT的81.33%(122/150)(P<0.05)。钆双胺增强MRI对多发HCC结节和HCC结节＜20 mm的检出率分别为76.76%(109/142)和42.25%(60/142),明显优于增强CT的44.26%(54/122)和23.77%(29/122)(P<0.05)。钆双胺增强MRI及CT增强扫描HCC瘤灶随着时间延长均呈低信号/低密度表现趋势,其中钆双胺增强MRI肝胆特异期所有瘤灶全部呈低信号表现,检出率100%。114例患者经手术病理检查确认共有90个HCC结节存在包膜。钆双胺增强MRI显示HCC包膜的敏感度为85.56%(77/90),高于增强CT的50.00%(45/90)(P<0.05)。2种影像学方法在显示HCC包膜边缘强化特点方面差异无统计学意义(P>0.05)。结论钆双胺增强MRI扫描HCC结节检出率、包膜检出率均优于CT增强扫描,且能较好显示HCC瘤灶强化特点,尤其在肝胆特异期对HCC具有更高的诊断价值。

关键词: 钆双胺, 磁共振成像, 计算机体层成像, 肝细胞癌

Abstract: Objective To investigate the clinical value of gadolinium diamine enhanced magnetic resonance imaging (MRI) and enhanced computed tomography (CT) in the diagnosis of hepatocellular carcinoma (HCC) in Child-Pugh grade A patients. Methods A total of 114 Child-Pugh grade A patients with HCC admitted to our hospital from December 2018 to December 2020 were selected. All patients underwent gadolinium diamine enhanced MRI and enhanced CT. The detection rate of nodules, enhancement methods and detection rate of capsule between the 2 imaging methods were compared. Results All of the 114 patients were confirmed by pathology, and 150 HCC nodules were found. The sensitivity of gadolinium diamine enhanced MRI in detection of HCC nodules was 94.67%, which was significantly higher than that of enhanced CT (81.33%), (P<0.05). The detection rates of gadolinium diamine enhanced MRI in multiple nodules and HCC nodules <20 mm were 76.76% and 42.25%, respectively, which were significantly better than those of enhanced CT (44.26% and 23.77%), (P<0.05). Gadolinium diamine enhanced MRI and enhanced CT showed a trend of low signal/low density along with time when scanning HCC lesions. All HCC tumor lesions scanned by MRI showed low signals in hepatobiliary phase, with a detection rate of 100%. Ninety tumor nodules with capsules were found in 114 HCC patients, which were confirmed by pathology. The sensitivity of detecting the capsules of HCC nodules through gadolinium diamine enhanced MRI was 85.56%, which was significantly higher than that of enhanced CT 50.00% (P<0.05). There was no significant difference between the 2 imaging methods in observing the features of capsules surround HCC (P>0.05). Conclusion Gadolinium diamine enhanced MRI performs better than enhanced CT in detecting HCC nodules and tumor capsules. Gadolinium diamine enhanced MRI also performs better in showing enhancement characteristics of HCC, which has a higher diagnostic value for hepatobiliary specific phase HCC.

Key words: Gadolinium diamine, Magnetic resonance imaging, Computed tomography, Hepatocellular carcinoma

郭大可, 刘兵, 刘彬. 钆双胺增强MRI及CT增强诊断肝功能Child-Pugh A级肝细胞癌的价值分析[J]. 肝脏, 2021, 26(11): 1264-1267.

GUO Da-ke, LIU Bing, LIU Bin. The value of gadolinium diamine enhanced MRI and enhanced CT in the diagnosis of hepatocellular carcinoma in Child-Pugh grade A patients[J]. Chinese Hepatolgy, 2021, 26(11): 1264-1267.

参考文献

[1] 陈琼荣. 早期小肝细胞癌的病理特征. 中华病理学杂志, 2020, 49:1353-1357.
[2] Sagnelli E, Macera M, Russo A, et al. Epidemiological and etiological variations in hepatocellular carcinoma. Infection, 2020, 48:7-17.
[3] 冯文秋, 迟红卫, 陈艳芳. 钆塞酸增强MRI对诊断小肝癌及其鉴别诊断的临床意义和应用价值. 肝脏, 2019, 24:1037-1040.
[4] 郑登峰, 卢艳龙. 肝脏动态增强CT与肝脏MRI诊断肝细胞癌对比分析. 中华肿瘤防治杂志, 2019, 26:87-88.
[5] 邢飞, 陆健, 张涛, 等. 肝硬化背景下肝细胞癌Gd-EOB-DTPA和MDCT表现:基于LI-RADS(2014版)分类标准的对照研究. 临床放射学杂志, 2018, 37:257-261.
[6] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版). 中华消化外科杂志, 2017, 16:635-647.
[7] Longerich T. Hepatocellular carcinoma. Pathologe, 2020, 41:478-487.
[8] Ranganathan S, Lopez-Terrada D, Alaggio R. Hepatoblastoma and pediatric hepatocellular carcinoma: an update. Pediatr Dev Pathol, 2020, 23:79-95.
[9] 杨丽, 曾蒙苏, 饶圣祥, 等. 微小肝细胞癌(≤1 cm)的钆塞酸二钠增强MRI表现分析. 放射学实践, 2020, 35:50-55.
[10] 高芬, 蔡萍, 刘晨, 等. 肝细胞癌癌前结节影像学特征的研究进展. 中华肝脏病杂志, 2020, 28:9-13.
[11] Imbriaco M, De Luca S, Coppola M, et al. Diagnostic accuracy of Gd-EOB-DTPA for detection hepatocellular carcinoma (HCC): a comparative study with dynamic contrast enhanced magnetic resonance imaging (MRI) and dynamic contrast enhanced computed tomography (CT). Pol J Radiol, 2017, 82:50-57.
[12] Rimola J, Davenport MS, Liu PS, et al. Diagnostic accuracy of MRI with extracellular vs hepatobiliary contrast material for detection of residual hepatocellular carcinoma after locoregional treatment. Abdom Radiol (NY). 2019, 44:549-558.
[13] 方勇超, 王强, 唐权, 等. MSCT与MRI动态增强扫描对高血供肝内胆管癌与肝细胞癌的诊断价值分析. 实用肝脏病杂志, 2020, 23:885-888.
[14] 周西, 刘启榆, 杨伟, 等. CT能谱成像与MRI在肝细胞癌TACE术后疗效评估中的对比研究. 肝脏, 2020, 25:409-412.
[15] 胡梦洁, 郁义星, 范艳芬, 等. 钆塞酸二钠增强磁共振影像学特征联合定量分析在预测肝细胞癌病理分级中的价值. 中华医学杂志, 2020, 100:1299-1304.
[16] Zhu F, Yang F, Li J, et al. Incomplete tumor capsule on preoperative imaging reveals microvascular invasion in hepatocellular carcinoma: a systematic review and meta-analysis. Abdom Radiol (NY), 2019, 44:3049-3057.