普美显动态增强MRI和动态增强CT对肝细胞肝癌血供的评估与病理对照分析

Primovist Dynamic-Enhanced MRI and Dynamic-Enhanced CT in the Evaluation of Hepatocellular Carcinoma Blood Supply and Pathological Comparison Analysis

目的基于普美显(EOB)动态增强MRI和动态增强CT检查探讨肝细胞肝癌(HCC)的血供特点并与病理对照分析。方法回顾性分析经手术病理证实为HCC患者36例共计43个病灶,术前同时行EOB动态增强MRI及动态增强CT检查。根据手术病理结果将HCC患者分为高分化组(12个)、中分化组(22个)和低分化组(9个)。观察HCC在动脉期强化、门静脉期流出及延迟期流出的情况;同时分别计算三期HCC-肝脏对比度(Cm)和肝胆期Cm及相对强化率(CER),并与病理结果对照分析。结果延迟期流出对HCC检出EOB-MRI优于CT(P=0.019)。CT动脉期Cm大于EOB-MRI(P=0.030),而EOB-MRI延迟期Cm远小于CT(P<0.001)。与动脉期Cm及肝胆期Cm相比,肝胆期CER与HCC分化程度之间相关性更好(r=0.476,P=0.001)。结论对于HCC血供显示,动脉期动态增强CT优于EOB-MRI,而延迟期EOB-MRI优于动态增强CT;肝胆期CER越大预示HCC分化程度较好。

Objective Based on the Primovist dynamic-enhanced MRI and dynamic-enhanced CT,the blood supply characteristics of hepatocellular carcinoma(HCC)were analyzed and compared with pathology.Methods A retrospective analysis of 36 patients with HCC confirmed by surgery and pathology.A total of 43 lesions,Primovist dynamic-enhanced MRI and dynamic-enhanced CT were performed simultaneously before operation.According to the pathological results of surgery,HCC patients can be divided into well-differentiated group(12),moderately-differentiated group(22)and poorly-differentiated group(9).According to the dynamic three-phase scan to observe the enhancement of HCC in the arterial phase,the outflow in the portal phase and the outflow in the delayed phase;at the same time,the three-phase HCC-liver contrast(CM)and hepatobiliary phase CM and HCC-liver contrast enhancement ratio(CER)are calculated separately,And compare and analyze with pathological results.Results EOB is better than CT for detection of HCC in delayed outflow(P=0.019).CT arterial phase CM was greater than EOB(P=0.030),and EOB delay phase CM was much smaller than CT(P<0.001).Compared with arterial CM and hepatobiliary CM,the correlation between hepatobiliary CER and HCC differentiation was better(r=0.476,P=0.001).Conclusion For the blood supply of HCC,dynamic enhanced CT in the arterial phase is better than EOB-MRI,and EOB-MRI in the delayed phase is better than dynamic enhanced CT;the greater the relative enhancement rate in the hepatobiliary phase,the better the differentiation of HCC.