钆塞酸二钠增强MRI在高度异型增生结节转化富血供肝细胞癌风险评估中的应用

摘要/Abstract

摘要： 目的研究钆塞酸二钠(Gd-EOB-DTPA)增强核磁共振(MRI)在高度异型增生结节(HGDN)转化富血供肝细胞癌(HCC)风险评估中的应用。方法回顾性收集2015年8月到2019年8月海安市人民医院接受检查的72例HGDN患者临床信息,按照其随访后是否发生富血供HCC将其分为HGDN组(n=39)和HCC组(n=33),两组皆在进入医院确诊当天检查Gd-EOB-DTPA增强MRI,记录病灶结节数及直径,分析两组轴位T1加权成像(T1WI)、轴位T2加权成像(T2WI)、扩散加权成像(DWI)、肝胆期及动静脉期相对于正常肝实质的高、等、低信号,同时通过 Kappa检验分析Gd-EOB-DTPA增强MRI扫描诊断富血供HCC时的灵敏度、特异度、准确率。结果 HGDN转化富血供HCC发生率为45.83%(33/72),HCC患者病灶结节检出率为44.35%(51/114)。HGDN组等高信号T1WI、低等信号T2WI、高等信号肝胆期、等低信号DWI患者比例显著高于HCC组(65.08% vs 37.25%,57.14% vs 31.37%,77.78% vs 11.76%,74.60% vs 23.53%),动脉期强化、门静脉期廓清患者比例显著低于HCC组(34.92% vs 54.90%,28.57% vs 49.02%),差异有统计学意义(P<0.05)。Gd-EOB-DTPA增强MRI预测HGDN转化为富血供HCC的灵敏度为87.88%,特异度为84.62%,准确率为86.11%,Kappa值为0.722。结论 Gd-EOB-DTPA增强MRI在HGDN转化富血供HCC的风险评估中具有较高价值,值得临床推广。

关键词: 钆塞酸二钠, 核磁共振, 高度异型增生结节, 肝细胞癌, 富血供转化

Abstract: Objective To study the application of Gd-EOB-DTPA enhanced magnetic resonance imaging (MRI) in risk assessment of highly dysplastic nodules (HGDN) transforming into blood rich hepatocellular carcinoma (HCC). Methods The clinical data of 72 patients with hgdn diagnosed in our hospital from August 2015 to August 2019 were retrospectively collected. According to the occurrence of hypervascular HCC after follow-up, they were divided into hgdn group (n = 39) and HCC group (n = 33),GD EOB DTPA enhanced MRI was detected at the first admission in both groups, and the number and diameter of nodules were recorded. The axial T1 weighted imaging (T1WI), axial T2 weighted imaging (T2WI), diffusion weighted imaging (DWI), high, equal and low signal of hepatobiliary phase and arteriovenous phase relative to normal liver parenchyma were analyzed Kappa test was used to analyze the sensitivity, specificity and accuracy of GD EOB DTPA enhanced MRI in the diagnosis of hypervascular HCC. Results The incidence of hgdn transformed and blood rich HCC was 45.83% (33/72), and the detection rate of focal nodules in HCC patients was 44.35% (51/114).The proportion of patients with high signal T1WI, low signal T2WI, high signal hepatobiliary stage and isolow signal DWI in hgdn group was significantly higher than that in HCC group (65.08% vs 37.25%, 57.14% vs31.37%, 77.78% vs 11.76%, 74.60% vs23.53%), and the proportion of patients with arterial enhancement and portal vein clearance was significantly lower than that of HCC group (34.92% vs 54.90%, 28.57% vs 49.02%), and the difference was statistically significant (P < 0.05).The sensitivity, specificity, accuracy and kappa value of GD EOB DTPA enhanced MRI were 87.88%, 84.62%, 86.11% and 0.722 respectively. Conclusion GD EOB DTPA enhanced MRI has high value in the risk assessment of hgdn transforming into blood rich HCC, which is worthy of clinical promotion.
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Key words: Gadolinium selenate disodium, Nuclear magnetic resonance, Highly dysplastic nodules, Hepatocellular carcinoma, Hypervascular transformation

范恒亮, 张为, 许亚春. 钆塞酸二钠增强MRI在高度异型增生结节转化富血供肝细胞癌风险评估中的应用[J]. 肝脏, 2021, 26(12): 1332-1335.

FAN Heng-liang, ZHANG Wei, XU Ya-chun. Application of gadolinium selenite disodium enhanced MRI in risk assessment of highly dysplastic nodules transforming into blood rich hepatocellular carcinoma[J]. Chinese Hepatolgy, 2021, 26(12): 1332-1335.

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