钆塞酸增强MRI与多排螺旋CT在结直肠癌肝转移评估中的诊断性能对比研究

A comparative study of the diagnostic performance of gadoxetic acid-enhanced hepatic MRI and multislice CT in the evaluation of colorectal liver metastases

目的比较钆塞酸(gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid,Gd-EOB)增强磁共振成像(magnetic resonance imaging,MRI)和多排螺旋CT(multi-detector computed tomography,MDCT)在检测结直肠癌(metastatic colorectal cancer,mCRC)肝转移中的诊断性能。方法回顾性收集了2019年5月—2022年6月中南大学湘雅医学院附属海口医院和空军军医大学西京医院128例确诊为mCRC的患者。所有患者接受了Gd-EOB MRI和MDCT成像。三名放射科医师分别判断两种检查方式诊断结直肠肝转移的准确性、灵敏度、特异度、阳性预测值和阴性预测值。结果128例确诊为mCRC的患者中,共获取462个病灶,经病理证实转移阳性424个和阴性38个。在医师A的判读中,Gd-EOB MRI判断肝转移阳性404个,阴性38个,准确度95.67%,灵敏度95.28%,特异度100.00%,阳性预测值100%,阴性预测值65.52%;MDCT判断肝转移阳性337个,阴性37个,准确度80.95%,灵敏度79.48%,特异度97.37%,阳性预测值99.70%,阴性预测值29.84%。在医师B的判读中,Gd-EOB MRI判断肝转移阳性403个,阴性36个,准确度95.02%,灵敏度95.05%,特异度94.74%,阳性预测值99.51%,阴性预测值64.91%;MDCT判断肝转移阳性335个,阴性35个,准确度80.09%,灵敏度79.01%,特异度92.11%,阳性预测值99.11%,阴性预测值28.23%。在医师C的判读中,Gd-EOB MRI判断肝转移阳性406个,阴性38个,准确度96.10%,灵敏度95.75%,特异度100.00%,阳性预测值100.00%,阴性预测值67.86%;MDCT判断肝转移阳性352个,阴性34个,准确度83.55%,灵敏度83.02%,特异度89.47%,阳性预测值98.88%,阴性预测值32.08%。Gd-EOB MRI判断肝转移性质的准确性、灵敏度和阴性预测值均高于MDCT,在医师A和医师C的判断中,与病理检查结果的一致性较好(Kappa值为0.770、0.788),在医师B的判断中,与病理检查结果的一致性一般(Kappa=0.731);而MDCT检查的结果与病理检查结果的一致性较差(Kappa值分别为0.379、0.378和0.400)。结论Gd-EOB MRI诊断mCRC肝转移的准确度、灵敏度和阳性预测率均高于MDCT,诊断性能更高,能够为临床鉴别诊断提供更多有价值的参考信息。包膜下病变、周围胆道转移和肝脏脂肪病变会降低MDCT诊断mCRC的性能。相对于MDCT,Gd-EOB MRI可以提供更准确的结果。

Objective To compare the diagnostic performance of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB) enhanced magnetic resonance imaging(MRI) and multi-detector computed tomography(MDCT) in detecting liver metastases from metastatic colorectal cancer(mCRC).Methods We made a retrospective collection of 128 patients diagnosed with mCRC from May 2019 to June 2022 at Haikou Hospital,Xiangya School of Medicine,Central South University and Xijing Hospital,Air Force Military Medical University.All patients underwent Gd-EOB MRI and MDCT imaging.Three radiologists judged the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of the two modalities for colorectal liver metastases,respectively.Results Of the 128 patients diagnosed with mCRC,a total of 462 lesions were obtained,with 424 positive and 38 negative metastases confirmed by pathology.In the interpretation of physician A,Gd-EOB MRI judged 404 positive and 38 negative liver metastases,with accuracy of 95.67%,sensitivity of 95.28%,specificity of 100.00%,a positive predictive value of 100%,and a negative predictive value of 65.52%.MDCT judged 337 positive and 37 negative liver metastases,with accuracy of 80.95%,sensitivity of 79.48% and specificity of 97.37%,a positive predictive value of 99.70%,and a negative predictive value of 29.84%.In the interpretation of physician B,Gd-EOB MRI judged 403 positive and 36 negative liver metastases,with accuracy of 95.02%,sensitivity of 95.05%,specificity of 94.74%,a positive predictive value of 99.51%,and a negative predictive value of 64.91%.MDCT judged 335 positive and 35 negative liver metastases,with accuracy of 80.09%,sensitivity of 79.01%,specificity of 92.11%,a positive predictive value of 99.11%,and a negative predictive value of 28.23%.In the interpretation of physician C,Gd-EOB MRI judged 406 positive and 38 negative liver metastases,with accuracy of 96.10%,sensitivity of 95.75%,specificity of 100.00%,a positive predictive value of 100.00%,and a negative predictive value of 67.86%.MDCT judged 352 positive and 34 negative liver metastases,with accuracy of 83.55%,sensitivity of 83.02%,specificity of 89.47%,a positive predictive value of 98.88%,and a negative predictive value of 32.08%.Gd-EOB MRI judged the nature of liver metastases with higher accuracy,sensitivity and negative predictive value than MDCT,and had better agreement with pathological examination results in the judgment of physician A and physician C(Kappa=0.770,0.788).In physician B's judgment,the agreement with pathological findings was fair(Kappa=0.731),while the agreement between the results of MDCT examination and pathological findings was poor(Kappa=0.379,0.378 and 0.400).Conclusion Gd-EOB MRI has higher accuracy,sensitivity and positive predictive rate than MDCT in diagnosing colorectal liver metastasis,and has higher diagnostic performance.Therefore,it can provide more valuable reference information for clinical differential diagnosis.Subcapsular lesions,peribiliary metastases and hepatic steatosis can reduce the diagnostic performance of MDCT,while Gd-EOB MRI detection can provide more accurate results than MDCT.