Gd-EOB-DTPA肝胆期MRI结合DWI对原发性肝细胞癌的检出价值

Diagnostic accuracy of Gd-EOB-DTPA-enhanced hepatobiliary phase MRI imaging combined with DW-MRI for hepatocellular carcinoma

目的在常规动态对比增强MRI的基础上,探讨Gd-EOB-DTPA增强MR扫描肝胆期结合扩散加权成像序列(DW-MRI)诊断原发性肝细胞癌的价值。方法回顾性分析60例怀疑原发性肝细胞癌(hepatocellular carcinoma,HCC)患者的Gd-EOB-DTPA增强MR扫描动脉期、门脉期、肝胆期及DWI图像资料。分为3组进行阅读和比较,分析影像特征,获得最终影像诊断结果。以手术病理为标准,采用受试者工作特征曲线(ROC)曲线下面积(AUC)分析Gd-EOB-DTPA肝胆期结合DWI序列对HCC的诊断价值。结果 60例患者共发现肝内病灶80个,其中40例患者共诊断56个HCC,其中22个直径≤2 cm。在常规动态对比增强MR扫描基础上,结合Gd-EOB-DTPA肝胆期及DW-MRI不能增加对所有大小的HCC的诊断准确性,但对直径≤2 cm的早期HCC的准确性最高(P=0.024 8),且当仅结合Gd-EOB-DTPA增强MR扫描肝胆期时,其诊断准确性亦高于常规对比动态增强扫描(P=0.043 2),具统计学意义。结论在常规动态对比增强MR基础上,结合Gd-EOB-DTPA增强肝胆期图像和DWI序列有助于诊断直径≤2 cm的早期HCC,可以作为常规MR序列的有效补充。

Objective To investigate the diagnostic value of Gd-EOB-DTPA-enhanced hepatobiliary phase MR imaging combined with diffusion-weighted MR imaging （DW-MRI） in the detection of hepatoeellular carcinoma （HCC） with histopathology as reference standard. Methods A total of 60 patients who were suspected with HCC admitted in our hospital from January to November 2013 were recruited in this study and their data were collected and retrospectively reviewed. They underwent Gd-EOB-DTPA-enhanced arterial phase （HAP）, portal venous phase （PVP） , hepatobiliary phase （HP） MR and DW MRI before surgery and histopathological biopsy. Three groups of images were assigned and compared. Two radiologists graded likelihood of HCC with a five-point confidence scale. The accuracy of MR imaging protocols in detecting HCC was analyzed by the receiver operating characteristic （ROC） curve with the histopathology as reference standard. Results Based on the histopathological analyses, 56 HCCs were demonstrated in this study and 22 HCCs less than 2 cm in diameters were observed. Combined with Gd-EOB-DTPA-enhanced hepabiliary phase MRI and DWI showed greatest ability in identification of HCC （ ≤ 2 em） compared with conventional dynamic enhanced MRI （ P = 0. 024 8 ）. The accuracy of adding Gd-EOB-DTPA-enhanced hepabiliary phase MRI in diagnosis of HCC （ ≤2 cm） was greater than conventional dynamic enhanced MRI alone （P = 0. 043 2）. However, combined both Gd-EOB-DTPA-enhanced hepabiliary phase MRI and DW- MRI had similar ability in detection of HCC with variable size in this cohort. Conclusion Combining Gd- EOB-DTPA-enhanced hepabiliary phase MRI and DW-MRI is more helpful in the diagnosis of HCC, especially early HCC less than 2 cm in diameter, than conventional dynamic enhanced MRI.