基于肝细胞特异性MRI对比剂的肝硬化背景良恶性的鉴别诊断价值

Differential diagnosis of benign and malignant cirrhosis based on hepatocellular specific MRI contrast agent

目的:探讨基于肝细胞特异性磁共振成像(MRI)对比剂的肝硬化背景良恶性鉴别诊断价值。方法:96例肝硬化患者经影像学检查发现的肝脏结节均行肝细胞特异性对比剂钆塞酸二钠(Gd-EOB-DTPA)增强扫描,根据手术或穿刺病理结果分为RN组、DN组和HCC组。比较3组结节Gd-EOB-DTPA增强MRI扫描参数;以病理诊断结果为“金标准”,评价基于Gd-EOB-DTPA对比剂的MRI扫描诊断肝硬化背景下HCC的敏感度、特异度、准确度、阳性预测值、阴性预测值。结果:96例肝硬化患者经影像学检查共发现110个病灶,病理诊断RN 21个、DN 40个和HCC 49个。HCC组、DN组、RN组ADC值依次升高,组间比较差异有统计学意义(P<0.05);HCC组T1值、T1值增加率高于DN组和RN组,差异有统计学意义(P<0.05);以病理诊断为“金标准”,Gd-EOB-DTPA增强MRI诊断HCC敏感度、特异度、准确度、阳性预测值、阴性预测值、Kappa值分别为90.48%、94.38%、93.64%、79.17%、97.67%、0.80。结论:基于肝细胞特异性对比剂Gd-EOB-DTPA的MRI增强扫描可鉴别肝硬化背景下良恶性结节,对HCC有较高诊断价值。

Objective:To explore the value of liver cell-specific magnetic resonance imaging(MRI)contrast agent in the diagnosis of benign and malignant cirrhosis.Methods:96 patients with cirrhosis were included,imaging examination revealed liver nodules,liver cell specific contrast agent GD-Eob-DTPA was used for MRI enhancement.They were divided into RN group,DN group and HCC group according to surgical or puncture pathological results,GD-Eob-DTPA enhanced MRI scan parameters of nodules in the three groups were compared.Pathological diagnosis as the“gold standard”,to evaluate the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of MRI scan based on GD-Eob-DTPA contrast agent in the diagnosis of HCC in the background of cirrhosis.Results:Among 96 patients,a total of 110 lesions were found by imaging examination,including 21 pathologically diagnosed RN,40 DN and 49 HCC,they were included in RN group,DN group and HCC group.The ADC values of the HCC group,DN group and RN group increased successively,and the differences between the groups were statistically significant(P<0.05).T1 value and the increase rate of T1 value in HCC group was higher than that in DN group and RN group,the differences were statistically significant(P<0.05).Taking pathological diagnosis as the“gold standard”,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa value of GD-Eob-DTPA enhanced MRI for HCC diagnosis were 90.48%,94.38%,93.64%,79.17%,97.67%,0.80,respectively.Conclusion:Enhanced MRI scanning based on liver cell-specific contrast agent GD-Eob-DTPA can distinguish benign and malignant nodules in the background of liver cirrhosis,which has high diagnostic value for HCC.