关于钆塞酸二钠及钆喷酸葡胺增强MRI对肝癌诊断效能的1∶1匹配的病例对照研究

A 1∶1 Matched Case-Control Study on the Efficacy between Gadoxetate Disodium and Gadopentetate Dimeglumine-Enhanced MRI for Diagnosing Liver Cancer

目的通过1∶1匹配的病例对照研究,比较钆塞酸二钠(Gd-EOB-DTPA)和钆喷酸葡胺(Gd-DTPA)增强MRI对肝癌(HCC)的诊断效能,并且明确Gd-EOB-DTPA增强MRI的肝胆期是否具有补偿作用。方法搜集行Gd-EOB-DTPA以及Gd-DTPA增强MRI检查且有肝硬化、存在肝占位性病变的患者,按年龄±2岁、性别、病灶大小±1 cm(肿瘤最小直径为1 cm)进行1∶1匹配,两组均入组87例。两位医师根据肝脏影像报告和数据系统(LI-RADS)标准对Gd-EOB-DTPA三、四期及Gd-DTPA三期增强图像进行诊断分级,将LR-4、5的病例诊断为HCC。计算三种方法的灵敏度、特异度及准确率,并比较增加肝胆期后LI-RADS分级的变化。结果 Gd-EOB-DTPA四期扫描较Gd-DTPA三期扫描的诊断灵敏度及准确率更高,差异具有统计学意义(P=0.028)。Gd-DTPA及Gd-EOB-DTPA三期扫描诊断效能基本一致,差异无统计学意义(P=0.701);Gd-EOB-DTPA四期增强扫描较三期的诊断效能增高(P=0.011),差异有统计学意义,即肝胆期使Gd-EOB-DTPA的诊断效能提高。增加肝胆期后,有16.0%(13/81)病变的LI-RADS分级发生变化,更正了9个病灶的影像诊断。结论由于肝胆期的补偿作用,Gd-EOB-DTPA较Gd-DTPA的诊断准确率、灵敏度、特异度均有所提高。而且Gd-EOB-DTPA增强MRI可以提高LI-RADS分级的准确性。

Objective A 1∶1 matched case-control study was used to compare the efficacy of gadoxetate disodium(Gd-EOB-DTPA) and Gadopentetate dimeglumine(Gd-DTPA)-enhanced MRI in diagnosing liver cancer(HCC),and to clarify whether the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI has a compensatory effect. Methods Patients with liver cirrhosis and intrahepatic lesions who underwent Gd-EOB-DTPA or Gd-DTPA enhancement were retrospectively collected.A 1∶1 match was performed according to age ±2 years, gender and lesion size ±1 cm(minimum tumor diameter was 1 cm).Eighty-seven patients were enrolled in both groups. Two physicians classified the images of Gd-EOB-DTPA three and four-phases and Gd-DTPA three-phases enhanced MRI according to the LI-RADS criteria, and diagnosed the casesof grade LR-4 and 5 as HCC. We calculated the sensitivity, specificity and accuracy of the three groups, and compared the changes of LI-RADS grade after adding the hepatobiliary phase. Results The sensitivity, specificity and accuracy of Gd-EOB-DTPA four-phases enhanced MRI were higher than that of Gd-DTPA three-phases enhanced MRI(P=0.028),indicating that the diagnostic efficiency of Gd-EOB-DTPA was higher.The diagnostic accuracy of Gd-DTPA and Gd-EOB-DTPA three-phases enhanced MRI was not statistically significant(P=0.701).That is the efficacy of Gd-DTPA and Gd-EOB-DTPA three-phases enhanced MRI were similar.Inaddition, the diagnostic efficiency of Gd-EOB-DTPA four-phases enhanced MRI was higher than that in the three-phases enhanced MRI(P=0.011),and the difference was statistically significant.In other words, the existence of hepatobiliary phase improved the diagnostic efficiency of Gd-EOB-DTPA.After increasing the hepatobiliary phase, 16.0%(13/81) of lesions’ LI-RADS grade was changed, and the diagnoses of nine lesions were corrected. Conclusion Due to the compensatory sation effect of hepatobiliary phase, Gd-EOB-DTPA-enhanced MRI has improved diagnostic accuracy, sensitivity and specificity, when compared with Gd-DTPA-enhanced MRI.Gd-EOB-DTPA-enhanced MRI can improve the accuracy of LI-RADS classification, and the combination of the two can optimize accurate diagnosis.