钆塞酸二钠增强MRI对门脉期无廓清小肝癌的诊断价值

Diagnostic performance of Gd-EOB-DTPA enhanced MRI in portal venous phase non-washout hepatocellular carcinoma

目的探讨在肝癌高危因素背景下,钆塞酸二钠(Gd-EOB-DTPA)增强MRI对门脉期无廓清小肝癌(sHCC)的诊断价值。方法采用Gd-EOB-DTPA增强MRI检查有肝癌高危因素、门脉期无廓清肝结节患者44例,50个肝结节。手术切除或穿刺肝结节做病理学检查。分析结节的影像征象及基于影像征象建立模型的诊断效能。结果Gd-EOB-DTPA增强MRI门脉期无廓清的结节中,sHCC组和非-sHCC(Non-sHCC)组间的动脉期非环形高强化、移行期低信号、结节包膜、DWI高信号、T2WI轻-中度高信号、T1WI低信号的差异具有统计学意义(P<0.05)。Logistic回归分析提示,移行期低信号、结节包膜为sHCC的独立危险因素。移行期低信号、结节包膜及联合诊断门脉期无廓清sHCC的灵敏度、特异度、准确度分别为72.7%、70.6%、72.0%,78.8%、94.1%、84.0%和93.9%、70.6%、86.0%,ROC曲线下面积分别为0.717、0.865、0.905。结论在肝癌高危因素背景下,Gd-EOB-DTPA增强MRI对门脉期无廓清sHCC的诊断效能较高,移行期低信号联合结节包膜征象分析可以进一步提高Gd-EOB-DTPA增强MRI对门脉期无廓清sHCC的诊断效能。

Objective To investigate the diagnostic performance of Gd-EOB-DTPA enhanced MRI for small hepatocellular carcinoma(sHCC)non-washout in portal venous phase with high risk for hepatocellular carcinoma(HCC).Methods 44 patients with high-risk for HCC underwent Gd-EOB-DTPA-enhanced MRI,in total 50 nodules non-washout in portal venous phase and further pathological diagnosis was underwent by surgical resection or puncture biopsy.The difference between groups of liver nodule image features and the diagnostic performance of the model based on the image features was analyzed.Results Among the nodule non-washout in the portal venous phase of Gd-EOB-DTPA enhanced MRI,there were statistically significant differences between sHCC and Non-sHCC groups in nonrim-like enhancement in arterial phase,transitional phase hypointensity,nodular capsule,restricted diffusion in DWI,mild-moderate T2 hyperintensity,and hypointensity in T1WI(P<0.05).Multivariate logistic regression analysis showed that the transitional phase hypointensity,nodular capsule were independent risk factors for sHCC.The sensitivity,specificity and accuracy of transitional phase hypointensity,nodular capsule and the combined diagnosis of sHCC non-washout in portal venous phase were 72.7%,70.6%,72.0%,78.8%,94.1%,84.0%and 93.9%,70.6%,86.0%,respectively.The areas under ROC curve were 0.717,0.865 and 0.905,respectively.Conclusion With high risk for HCC,Gd-EOB-DTPA enhanced MRI has high diagnostic efficiency in portal venous phase non-washout hepatocellular.The combination of low signal during migration and analysis of nodular capsule sign can further improve the diagnostic efficacy of Gd-EOB-DTPA which enhanced the diagnostic efficiency of MRI in portal venous phase non-washout hepatocellular.