3.0T磁共振钆塞酸二钠增强扫描对肝硬化患者肝脏再生结节良恶性质的鉴别诊断价值

Differential diagnostic value of gadoxetic acid disodium enhanced 3.0T MRI for hepatic nodules in patients with liver cirrhosis

目的探讨钆塞酸二钠(Gd-EOB-DTPA)磁共振增强扫描对肝硬化患者肝脏再生结节良恶性质的鉴别诊断价值。方法选择2015年1月~2017年1月海南省人民医院诊治的肝硬化失代偿期患者43例,均进行3.0T磁共振Gd-EOB-DTPA及传统对比剂钆喷葡胺(Gd-DTPA)增强扫描,总结良恶性肝脏再生结节在扫描各期的影像学特点,以手术病理结果为金标准,分析该扫描方法诊断病灶良恶性质的灵敏度和特异度。结果 Gd-EOB-DTPA增强扫描在肝胆期可发现Gd-DTPA增强扫描漏诊的肝脏恶性结节;Gd-EOB-DTPA增强扫描对肝脏良性结节的诊断并不优于Gd-DTPA增强扫描;Gd-EOB-DTPA增强扫描的肝胆期,病灶多数呈低信号,少数呈等信号或高信号(P <0.01);Gd-EOB-DTPA诊断肝硬化结节数明显优于Gd-DTPA(P <0.01);Gd-EOB-DTPA增强扫描诊断肝硬化患者肝脏再生结节为恶性病灶的灵敏度为93.18%,特异度为100.00%。结论 3.0T磁共振Gd-EOB-DTPA增强扫描对肝硬化患者肝脏异常灌注结节良恶性判断的敏感度和特异度高,具有鉴别诊断价值。

Objective To investigate the differential diagnostic value of gadoxetic acid disodium （Gd-EOB-DTPA） enhanced MRI for hepatic nodules in patients with liver cirrhosis. Methods From February 2015 to February 2017, in Hainan General Hospital, 43 patients with liver cirrhosis were selected, and they were given Gd-EOB-DTPA enhanced 3.0T dynamic MRI and conventional Gd-DTPA enhancement. The characteristics of the images in various phases were analyzed, the results of surgical specimen pathology were as gold standard, the test sensitivity and specificity of Gd-EOB-DTPA were evaluated. Results Gd-EOB-DTPA enhanced 3.0T MRI imaging could detected malignant nodules in the liver- specific stage, which were not found by conventional Gd-DTPA enhancement imaging. Compared with conventional Gd-DTPA enhancement, Gd-EOB-DTPA enhanced MRI detected more malignant nodules and it was not better than Gd-DTPA enhancement in detecting benign nodules. During the Gd-EOB-DTPA enhanced liver-gladder phase, most lesions appeared low signal intensity, and others appeared equal or high signal intensity （P 〈 0.01）. Gd-EOB-DTPA enhanced MRI was better than Gd-DTPA enhancement in detecting malignant nodules （P 〈 0.01）. The specificity of Gd-EOB-DTPA enhanced MRI was 100.00%, and the sensitivity was 93.18%. Conclusion Gd-EOB-DTPA enhanced MRI has high sensitivity and speeificity for the diagnosis of benign and malignant of liver′s abnormal perfusion nodules, and has differential diagnostic value.