比较钆塞酸二钠和钆喷酸葡胺增强MRI检查对乙肝肝硬化背景肝癌的诊断价值

Comparison of the Diagnostic Value with Gd-EOB-DTPA and Gd-DTPA for Hepatocellular Carcinomas( HCC) in Hepatitis B Induced Cirrhosis

目的探讨钆塞酸二钠(Gd-EOB-DTPA)MR扫描对乙肝肝硬化背景肝癌的诊断价值。方法 32例乙肝肝硬化患者共34个肝癌病灶,均行两种MR成像[模式1:T2WI、DWI、T1WI同反相位、Gd-DTPA动态增强(平扫、动脉期、门静脉期及延迟期);模式2:T2WI、DWI、T1WI同反相位、Gd-EOB-DTPA动态增强(平扫、动脉期、门静脉期、延迟期及肝胆期)]。由2名阅片者采用双盲法分析图像,记录病灶的信号特点、强化方式及阅片者的信心评分。比较两种成像模式下阅片者诊断肝癌信心评分、一致性、ROC曲线下的面积、敏感性及阳性预测值。结果 (1)模式2下两位阅片者诊断肝癌的信心评分均提高,差异有统计学意义(P<0.05);且2名阅片者在模式2下诊断肝癌的一致性均增加。(2)2名阅片者在模式2下诊断肝癌的ROC曲线下面积均较模式1增加,差异有统计学意义(P<0.05)。(3)2名阅片者在模式2下诊断肝癌的敏感性较模式1均提高,差异有统计学意义(P<0.05),阳性预测值差异均无统计学意义(P>0.05)。结论 Gd-EOB-DTPA MR扫描有助于提高阅片者对乙肝肝硬化背景肝癌的诊断信心从而提高诊断能力。

Objective To explore the diagnostic value of Gd-EOB-DTPA MRI for hepatocellular carcinomas（ HCC） in hepatitis B induced cirrhosis. Methods A total of 32 cirrhotic patients with 34 HCC lesions,all underwent two imaging sets of MRI,the first imaging set： T2 WI,DWI,T1 WI in-phase and opposed-phase and enhanced imaging（ native phase,arterial phase,portal-venous phase and late-phase）; the second imaging set： T2 WI,DWI,T1 WI in-phase and opposedphase and enhanced imaging（ native phase,arterial phase,portal-venous phase,late-phase and hepatobiliary phase）. Two separate blind image analyses of the two imaging sets were performed. The signal characteristic of all lesions,the enhancement styles,and the confidence scores were recorded. The confidence scores of the two imaging sets,consistency,area under the receiver operating characteristic（ ROC） curve,sensitivity and positive predictive values（ PPV） were compared.Results（ 1） The confidence scores of the observers for the second imaging set were higher than those of the first one by both observers and the differences were statistically significant（ P 〈 0. 05）. The consistency of the observers also increased.（ 2） The area under the ROC curve improved by both observers for the second imaging set,and significant differences were detected（ P 〈 0. 05）.（ 3） There was a significant increase of the diagnostic sensitivity of the two observers for the second imaging set（ P 〈 0. 05）. No significant differences were detected for the PPV by both observers（ P 〉 0. 05）.Conclusion Gd-EOB-DTPA MRI may improve the diagnostic efficacy of HCC in hepatitis B induced cirrhotic liver by increasing observer’s confidence.