钆贝葡胺诊断硬化肝小局灶性病变临床分析

Differential diagnostic value of Gd-BOPTA for small focal hepatic lesions in cirrhotic liver

目的探讨双功能MR对比剂钆贝葡胺(Gd-BOPTA)对硬化肝背景下小局灶性病变的鉴别诊断能力。方法51例肝硬化患者纳入研究,采用Gd-BOPTA进行肝脏动态增强扫描和肝胆期扫描,计算各序列肝实质信号强度、病灶-肝脏对噪比(CNR)的绝对值(|CNR|);比较平扫和增强后各期肝实质信号变化情况及病灶-肝脏|CNR|及其变化(Δ|CNR|)。结果51例患者中共计有94个小于3 cm的病灶,包括小肝癌26个,胆管细胞癌1个,转移癌37个,血管瘤9个,不典型增生结节11个,局灶性结节增生6个,肝细胞腺瘤1个,炎性病灶3个。Gd-BOPTA增强后各期肝实质信号及|CNR|均显著增加(P<0.001)。动脉期、门脉期和平衡期所有病灶符合应用常规含钆对比剂时的强化表现特征;肝胆期扫描时,局灶性结节增生呈等-高信号,3个肝细胞癌呈稍高信号,其余病灶呈相对低信号。结论 Gd-BOPTA动态增强扫描联合肝胆期扫描能提供硬化肝背景下小的局灶性病变的形态、血供、细胞来源及功能等信息,进而提高鉴别诊断准确性。

Objective To investigate the differential diagnostic value of dual function MR contrast Gd-BOPTA （Mutihance） for small focal hepatic lesions in cirrhotic liver. Methods Fifty-one patients with cirrhotic liver were involved in the study. All patients underwent the liver dynamic enhanced scan and hepatocyte-phase scanning with Gd-BOPTA. Signal intensity of the liver paranchyma and absolute value of carrier to noise ratio （CNR） of lesion-liver, i. e. ｜ CNR ｜, were calculated. The changes in signal of the liver parachyma and CNR as well as △ ｜CNR｜ of lesion-liver were compared between scan and enhanced scan. Results Of the 51 pateints, there were 94 lesions less than 3 cm including 26 hepatocullular carcinoma, 1 cholangiocarcinoma,37 metastases,9 hemangioma, 11 dys- plastic nodule ,6 focal nodular hyperplasia, 1 liver adenoma and 3 inflammatory pseudotumor. The signal intensity and ｜CNR｜ of lesion-liv- er were remarkably increased in all phases after Gd-BOPTA enhancement （P 〈 0. 001 ）. All of the lesions in arterial,portal and equilibri- um phases after Gd-BOPTA enhancement showed similar enhanced pattern compared with that of conventional contrast agent with gadolini- um. In delayed hepatocyte-phase, iso-/slightly hyper-intensity was showed in the lesion of focal nodular hyperplasia, relative hyper-intensi- ty in three hepatocellular carcinoma lesions. Relative hypo-intensity was showed in all of the rest of the lesions. Conclusion Gd-BOPTA dynamic enhancement scanning combined with hepatocyte-phase scanning can provide the information of morphology, blood supply, cell or- igin and function of small focal hepatic lesions in cirrhotic liver. It could increase the accuracy of differential diagnosis.