钆塞酸二钠增强MRI引导肝脏病灶穿刺活检的可行性

Feasibility of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI for guiding liver biopsy

目的观察钆塞酸二钠(Gd-EOB-DTPA)增强MRI用于引导肝脏病灶穿刺活检的可行性。方法对15例肝脏病变患者行Gd-EOB-DTPA增强MRI引导下穿刺活检,统计总操作时间及技术成功率(以取样标本满足病理、基因等检测要求为技术成功),观察术中及术后并发症。以手术病理或随访结果为标准,评估MRI引导肝脏病灶穿刺活检的诊断效能。结果于Gd-EOB-DTPA增强MRI引导下穿刺15个肝脏病灶,均一次穿刺成功,病灶最大径0.40~2.81 cm,平均(1.58±0.69)cm;肝胆期MRI 13个病灶呈明显低信号、2个呈稍低信号,图像质量均满足操作要求;技术成功率100%(15/15);总操作时间33~54 min,平均(40.33±6.56)min。5例术中见少量针道渗血,沿针道推入明胶海绵条后止血;其余10例术中、术后均未出现并发症。穿刺标本病理诊断10例肝细胞癌(HCC)、1例结肠癌肝转移、1例肝腺瘤及3例肝脏不典型增生结节伴轻度肝硬化,其中1例穿刺病理结果为肝脏不典型增生结节伴轻度肝硬化者术后病理结果为早期小HCC,其余穿刺病灶病理诊断均与最终临床诊断一致。MRI引导肝脏病灶穿刺活检的诊断敏感度为91.67%(11/12),特异度为100%(3/3),准确率为93.33%(14/15)。结论Gd-EOB-DTPA增强MRI用于引导肝脏病灶穿刺活检安全、可行。

Objective To observe the feasibility of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI for guiding liver biopsy.Methods Gd-EOB-DTPA enhanced MRI-guided percutaneous biopsy was performed in 15 patients with liver lesions.The operation time and success rate(biopsy was regarded as success when the specimens met the requirements of pathological,genetic and other tests)were calculated.The intraoperative and postoperative complications were recorded.Taken surgical pathological results or clinical follow-up results as the final diagnostic criteria,the diagnostic efficacy of MRI-guided biopsy was assessed.Results Under the guidance of Gd-EOB-DTPA enhanced MRI,biopsy of liver lesion was performed in 15 lesions by one puncture,respectively,and the maximum diameter of lesions were 0.40-2.81 cm,with an average of(1.58±0.69)cm.Hepatobiliary phase MRI showed 13 lesions as significantly and 2 lesions as slightly hypointensities,while the image quality met the requirements of operation.The success rate of operation was 100%(15/15).The total procedure time was 33-54 min,with an average of(40.33±6.56)min.Slightly bleeding occurred in 5 patients during procedures,which stopped after pushing gelatin sponges strips along the needle path.No complication happened during nor after procedures in the rest 10 patients.Pathological results of MRI-guided biopsy included hepatocellular carcinoma(HCC)in 10 cases,liver metastasis from colon cancer in 1 and liver adenoma in 1 case,and liver nodule of atypical hyperplasia with mild cirrhosis in 3 cases,and 1 of the latter was pathologically diagnosed as early small HCC after surgical resection,while the biopsy diagnosis of the other lesions were consistent with final clinical diagnosis.The accuracy of MRI-guided liver biopsy was 93.33%(14/15),the sensitivity was 91.67%(11/12)and the specificity was 100%(3/3).Conclusion Gd-EOB-DTPA enhanced MRI was safe and feasible for guiding percutaneous liver biopsy.