基于减影技术钆塞酸二钠增强MRI评估肝脏影像报告和数据系统主要征象的价值

Evaluation of the major features of liver imaging reporting and data system using Gd-EOB-DTPA enhanced MRI based on subtraction technique

目的探究减影技术在钆塞酸二钠增强MRI评估2018版肝脏影像报告和数据系统(LI-RADS)主要征象的价值。方法回顾性分析2019年1月至2020年7月在河南省人民医院87例高风险患者的117个经病理证实的肝细胞肝癌(HCC)的钆塞酸二钠增强MRI,分别于动脉期、门静脉期、减影图像及联合图像独立评估2018版LI-RADS主要征象:动脉期非环状高强化(Nonrim APHE)、非周边廓清、增强包膜,并根据2018版LI-RADS对病变进行分级。根据病灶大小(<20 mm、≥20 mm)、平扫T_(1)WI病变信号(等高信号、低信号)进行分组。对于LI-RADS主要征象的检出率及以LR-5为诊断标准的确诊率,多组间比较采用Cochran′s Q检验,两两组间比较采用McNemar检验。结果对于所有HCC、T_(1)WI低信号HCC和≥20 mm的HCC,动脉期减影图像的Nonrim APHE检出率高于动脉期图像(χ^(2)=12.190、12.500、10.083,P均<0.001),同时LR-5确诊率也高于动脉期图像(χ^(2)=14.450、12.500、10.083,P均<0.001)。对于<20 mm的HCC,联合动脉期和动脉期减影图像可以提高Nonrim APHE的检出率(χ^(2)=5.143,P=0.016)。对于所有HCC、T_(1)WI等高信号的HCC,联合门静脉期和门静脉期减影图像对非周边廓清的检出率高于门静脉期图像(χ^(2)=7.111、6.125,P=0.004、0.008)。所有分组减影图像对增强包膜的检出率均高于门静脉期图像(P均<0.017)。门静脉减影图像对所有HCC、≥20 mm HCC的LR-5确诊率高于门静脉期图像(χ^(2)=6.722、6.750,P=0.008、0.006)。动脉期和门静脉期双期减影图像对所有分组的LR-5确诊率均高于MRI图像(P均<0.013)。结论钆塞酸二钠动脉期、门静脉期减影图像在显示Nonrim APHE、非周边廓清和增强包膜方面的能力优于动脉期、门静脉期图像,从而可以提高HCC的LI-RADS分级。

Objective To explore the incremental value of subtraction technique in evaluating the major features of liver reporting and data system version 2018(LI-RADS v2018)on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI.Methods The Gd-EOB-DTPA enhanced MRI of 117 pathologically verified hepatocellualr carcinoma(HCC)from 87 high-risk patients in Henan Provincial People′s Hospital from January 2019 to July 2020 was analyzed retrospectively.The major features of LI-RADS in arterial phase,portal venous phase,subtraction and combined images were evaluated including nonrim arterial phase hyperenhancement(Nonrim APHE),nonperipheral washout and enhancing capsule.The lesions were graded according to LI-RADS v2018.According to the lesion size(<20 mm,≥20 mm)and T_(1)WI signal intensity(hypointensity,isointensity or hyperintensity),the patients were divided into different subgroups.Cochran′s Q test was used for the comparison of the detection rate of the major features of LI-RADS and the accurate diagnosis rate based on LR-5 as the diagnostic standard among multiple groups.McNemar test was used for the comparison between two groups.Results For all HCC,hypointensity HCC and HCC≥20 mm,the detection rate of Nonrim APHE(χ^(2)=12.190,12.500,10.083,all P<0.001)and the accurate diagnosis rate of HCC(χ^(2)=14.450,12.500,10.083,all P<0.001)of subtraction images from arterial phase were significantly higher than that of arterial images.For HCC<20 mm,the detection rate of Nonrim APHE combined with arterial phase images was significantly higher than that in arterial phase images(χ^(2)=5.143,P=0.016).For all HCC and isointensity or hyperintensity HCC,the detection rate of nonperipheral washout combined with portal venous phase images was higher than that in portal venous phase images(χ^(2)=7.111,6.125,P=0.004,0.008).The detection rate of enhancing capsule of subtraction images from portal venous phase was higher than that of portal venous phase images in all groups(all P<0.017).The accurate diagnosis rate of subtraction images from portal venous phase in all HCC and HCC≥20 mm was higher than that in portal venous phase images(χ^(2)=6.722,6.750,P=0.008,0.006).The accurate diagnosis rate of LR-5 in all groups using subtraction images from arterial phase and portal venous phase was higher than that of MRI images(all P<0.013).Conclusion For Gd-EOB-DTPA dynamic enhanced MRI,subtraction images from arterial phase and portal venous phase are better than arterial phase and portal venous phase images in displaying Nonrim APHE,nonperipheral washout and enhancing capsule,which can improve the LI-RADS classification of HCC.