钆塞酸二钠增强磁共振移行期和肝胆期低信号对肝细胞癌诊断的价值

The Value of Gadopentetate Disodium-Enhanced Magnetic Resonance Transitional and Hepatobiliary Phase Low Signal for the Diagnosis of Hepatocellular Carcinoma

目的探讨基于钆塞酸二钠增强磁共振移行期和肝胆期低信号的诊断模型对肝细胞癌的诊断价值。方法回顾性分析行钆塞酸二钠增强MRI并且获得病理结果或临床确诊的129例患者共178枚肝脏局灶性病灶,由两名医师独立评估并标注每个结节影像学征象,统计分析两种诊断模型对肝细胞癌的诊断效能,模型一为“动脉期非环形高强化+门静脉期廓清”,模型二为“动脉期非环形高强化+门静脉期/移行期/肝胆期廓清”。结果模型一及模型二的诊断敏感度、特异度及准确度分别为74.42%(96/129)、83.67%(41/49)、76.97%(137/178)及93.80%(121/129)、69.39%(34/49)、87.08%(155/178),模型二的敏感度及准确度高于模型一(P<0.05),并且当结节直径≤3 cm时,差异更加显著。而将两种模型联合DWI序列重新评估时,模型二诊断特异度明显提高,诊断效能进一步提高。结论钆塞酸二钠增强磁共振对肝细胞癌诊断效能较高,将移行期或肝胆期低信号代替门静脉期廓清作为新诊断模型,可以明显提高诊断肝细胞癌的敏感度,联合DWI进一步提高诊断效能。

Objective To investigate the diagnostic value of Gd-EOB-DTPA-enhanced MRI transition phase and hepa-tobiliary phase low signal for hepatocellular carcinoma.Methods A total of 178 nodules from 129 patients confirmed by pathology or clinical follow-up were included in the study among patients who underwent Gd-EOB-DTPA-enhanced MRI in the Affiliated Hospital of Guilin Medical College between January 2020 and April 2022.Two doctors independently evalua-ted and labeled each nodular imaging sign,and statistically analyzed the diagnostic efficacy of two diagnostic models for hep-atocellular carcinoma,the first model was“arterial phase hyperenhancement(APHE)and portal venous phase washout”,and the second model was“APHE,portal venous phase or transitional phase(TP)or hepatobiliary phase transitional phase(HBP)washout”.Results The sensitivity and accuracy with washout extended to the transitional phase and the hepato-biliary phase[93.80%(121 of 129),87.08%(155 of 178)]was better than that with washout confined to the portal ve-nous phase[74.42%(96 of 129),76.97%(137 of 178);P<0.05].The difference is more pronounced when the diameter of the nodules is less than or equal to 3 cm.When the DWI was combined,the specificity with extensions of washout to the transitional phase and hepatobiliary phase[85.71%(42 of 49)]was similar to that obtained with washout confined to the portal venous phase[87.76%(43 of 49);P=1.000].Conclusion Gd-EOB-DTPA-enhanced MRI has high diagnostic efficacy for hepatocellular carcinoma.The replacement of portal phase clearance with low signal in the transitional or hepa-tobiliary phase as a new diagnostic model can significantly improve the sensitivity of diagnosing HCC.Combined with DWI,the diagnostic efficiency is further improved.