基于Gd-E0B-DTPA结合大偏转角技术的肝局灶性病变定性诊断研究

Qualitative diagnosis of focal liver lesions based on Gd-E0B-DTPA combined with large deflection angle technique

目的探讨基于钆塞酸二钠(Gd-EOB-DTPA)结合大偏转角技术的肝局灶性病变定性诊断。方法选取肝局灶性病变患者62例,患者均进行Gd-EOB-DTPA增强MRI扫描,分别行5 min、10 min、20 min延迟扫描,采用常规的低偏转角(10°)及大偏转角(20°)法获得肝胆期图像,比较Gd-E0B-DTPA结合低偏转角及大偏转角对肝局灶性病变定性诊断的敏感度、特异度。结果经Kappa检验,在低偏转角、大偏转角检测肝局灶性病变的k值中,5 min分别为0.95、0.95,10 min分别为0.93、0.82,20 min分别为0.96、1.00;大偏转角成像的敏感度均明显高于低偏转角成像,差异均有统计意义(χ2分别=9.89、10.67、20.08、14.73、5.03、9.48,P均<0.05);病灶大小≤10 mm中大偏转角成像的敏感度均明显高于低偏转角成像,差异均有统计意义(χ2分别=4.22、4.89、8.42、8.42、12.52、12.52,P均<0.05),各时间点检测恶性病灶大偏转角成像的敏感度均明显高于低偏转角成像,差异均有统计意义(χ2分别=5.86、5.86、15.24、11.16、7.60、5.64,P均<0.05);肝癌中大偏转角成像的敏感度均明显高于低偏转角成像,差异均有统计意义(χ2分别=7.63、6.23、8.16、4.94、6.34、6.34,P均<0.05);在转移灶检测中两者无明显差异(χ2分别=0.29、0.29、3.41、3.41、0.21、0.21,P均>0.05)。结论 Gd-E0B-DTPA结合大偏转角技术可提高对肝局灶性病变定性诊断的敏感度,为临床制定治疗方案提供可靠资料。

Objective To investigate the qualitative diagnosis of focal liver lesions based on Gd-E0 B-DTPA combined with large deflection angle technique. Methods Totally 62 patients with focal liver lesions were selected. The patients underwent Gd-EOB-DTPA enhanced MRI scan at 5 min,10 min and 20 min delayed scanning respectively. The conventional low angle（10 degrees）and large deflection angle（20 degrees）were used to obtain hepatobiliary phase images. The sensitivity and specificity of qualitative diagnosis of focal liver lesions were compared between the Gd-E0 B-DTPA combined with the low deflection angle or the large deflection angle. Results At 5 minuts delayed scanning,the Kappa values of the low deflection angle and high deflection angle in detection of focal liver lesions were 0.95 and 0.95 respectively. At 10 minuts delayed scanning,the Kappa values were 0.93 and 0.82,at 20 minuts delayed scanning,the Kappa values were 0.96 and 1.00.The sensitivities of large deflection angle imaging were significantly higher than those of low deflection angle imaging at 5 min,10 min and 20 min delayed scanning（χ2=9.89,10.67,20.08,14.73,5.03,9.48,P〈0.05）. In patients with lesion size less than 10 mm,the sensitivity of large deflection angle imaging was significantly higher than that of low deflection angle imaging（χ2=4.22,4.89,8.42,8.42,12.52,12.52,P〈0.05）.The sensitivity of large deflection angle imaging for detecting malignant lesions was significantly higher than that of low deflection angle imaging（χ2=5.86,5.86,15.24,11.16,7.60,5.64,P〈0.05）as well as for detecting liver cancer（χ2=7.63,6.23,8.16,4.94,6.34,6.34,P〈0.05）. There was no difference in detection of metastases between two deflection angle imagings（χ2=0.29,0.29,3.41,3.41,0.21,0.21,P〈0.05）. Conclusion Gd-E0 BDTPA combined with large deflection angle technique can improve the sensitivity of qualitative diagnosis of focal liver lesions and provide reliable data for clinical treatment.