Gd-EOB-DTPA增强MRI在肝脏结节性病变中的价值

The value of Gd-EOB-DTPA in diagnosing hepatic nodules with MRI

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强核磁共振成像(MRI)在肝脏结节性病变中的检出及鉴别诊断价值。方法搜集行Gd-EOB-DTPA增强MRI检查肝脏占位性病变且明确病灶性质的患者70例。将图像分为有肝胆期图像和无肝胆期图像2组,比较2组图像对全部病灶检出率和病灶定性诊断的敏感性、特异性。结果对全部病灶的检出率无肝胆期图像组为92.7%(114/123),有肝胆期图像组为99.6%(122.5/123,P<0.05),其中无肝胆期图像对直径≤1 cm的的病灶平均检出率为84.2%(32/38),有肝胆期图像组对直径≤1 cm的病灶平均检出率为98.7%(37.5/38),有肝胆期图像组对直径≤1 cm的病灶检查率高于无肝胆期图像组(P<0.05)。2组图像对直径>1 cm的病灶平均检出率差异无统计学意义。Gd-EOB-DTPA增强MRI对肝脏结节性病灶诊断的敏感性为96.7%,特异性为96.9%。在肝癌诊断中,有肝胆期图像组肝癌检出率高于无肝胆期图像组[96.3%(52/54)与83.3%(45/54)],P<0.05。结论采用Gd-EOB-DTPA增强MRI不但能提高肝脏结节性病变病灶的检出率,还可提供病变形态、血供、细胞来源及功能等相关信息,以提高定性诊断的敏感性和特异性。

Objective To discuss the value of Gd-EOB-DTPA-enhanced MRI in diagnosis of nodulars in hepatic.Methods 70 patients with liver occupying lesions were diagnosed by Gd-EOB-DTPA-enhanced MRI. Images were divided into HBP image group（ T1 WI,T2 WI/FS,dynamic enhancement,HBP） and without HBP group（ T1 WI,T2 WI/FS and dynamic enhancement）. The detection rate and the sensitivity and specificity detection of liver cancer were compared between the two groups.Results The entire lesion detection rate without HBP image group was 92. 7%（ 114/123）,the HBP image group was 99. 6%（ 122. 5/123,P〈 0. 05）. The average detection rate of the lesion which was less than or equal to 1 cm in diameter was 84. 2%（ 32/38） in the non-HBP image group. The detection rate was 98. 7%（ 37. 5/38） in HBP image group. There were significant difference between the two group（ P〈 0. 05）. The lesion liver image of larger than 1 cm in diameter,on average,there was no evident difference between the two groups. The diagnostic sensitivity of Gd-EOB-DTPA enhanced MRI on the liver focal nodules was 96. 7%,the specificity was96. 9%,the total coincidence rate was 96. 7%. The detection sensitivity of HBP image in the diagnosis of liver cancer was higher than it without HBP image group [98. 2%（ 52/54） VS 83. 3%（ 45/54）,P 〈0. 05]. Conclusion Gd-EOB-DTPA enhanced MRI in the diagnosis of liver nodular lesions has a better diagnostic value,not only because it can provide lesions form,function and blood cell source,relevant information,it also can increase the detection rate and the sensitivity of the diagnosis lesions.