MRI与多层螺旋CT动态增强检测小肝细胞癌:受试者特性曲线分析

Dynamic enhancement MRI and multirow-detector helical CT for detection of small hepatocellular carcinoma with receiver operating characteristic analysis

目的比较多层螺旋CT(MDCT)与MRI动态增强扫描对患有慢性肝病及肝硬化患者中对小肝细胞癌(SHCC)检出的敏感性,评价不同影像技术的临床价值。方法37例纳入研究组,其中24例明确诊断SHCC,共43个病灶;MDCT快流率注射对比剂碘海醇后行多期扫描;MRI采用SE序列加快速扰相梯度回波序列(FMPSPGR),行钆喷替酸葡甲胺(Gd-DTPA)增强后动态扫描。对结果行受试者特性(ROC)曲线分析并统计检出敏感性。结果分析ROC曲线,MDCT快速注射对比剂后多期扫描对SHCC的诊断效率高于MR动态扫描,但曲线下面积Az值,两种方法间差异无统计学意义(P>0·05)。对瘤径≤1cm的微小肝癌(MHCC)检出敏感性,MDCT和MRI分别为90·0%、95·0%和70·0%、85·0%;对SHCC的阳性预测值MDCT增强后多期扫描略高于MR动态增强扫描,分别为97·5%、97·6%和90·7%、94·7%。结论对于慢性肝病及肝硬化病人的随访,建议采用MDCT增强后多期扫描,为及早发现SHCC或MHCC及早期治疗提供帮助。

Objective The purpose of this study was to compare gadolinium-enhanced multiphase dynamic MR imaging and multirow-detector helical CT (MDCT) multiphase scanning for detection of small hepatocellular carcinoma. Methods Multirow-detector helical CT multiphase scanning and MRI with SE sequence combined with FMPSPGR sequence were performed in 37 patients with 43 small HCCs. ROC curves were established to analyze the results for each modality. Results There was no statistical difference between MDCT and MRI in the areas below the receive operating characteristic curve (Az). The detection of small HCC on MDCT showed lesser false-positive lesions than that on MRI, however the difference was not statistically different. Sensitivity of detecting small HCC on MDCT with multiphase scanning was higher than that on dynamic MRI. The sensitivity of detection for small HCC (≤1 cm) was 90.0%, 95.0% on MDCT and 70.0%, 85.0% on MRI, respectively. The positive predictive values for small HCC were higher on dynamic MDCT (97.5%, 97.6%) than on dynamic MRI (90.7%, 94.7%), respectively. Conclusion For early detection of small HCC, multiphase hepatic CT scan using MDCT is highly recommended for the patients with chronic hepatitis and cirrhosis.