Gd-EOB-DTPA MRI联合超声造影对肝硬化背景<2 cm肝癌的诊断

摘要/Abstract

摘要： 目的分析钆塞酸二钠增强磁共振(Gd-EOB-DTPA MRI)联合超声造影(CEUS)对肝硬化背景下<2 cm肝细胞癌(HCC)即小肝癌(SHCC)的临床应用价值。方法回顾分析2015年1月至2019月12月具有HCC高危风险的肝脏局灶性结节(<2 cm)患者52例(男性36例、女性16例),年龄(56.8±9.0)岁。患者可完成Gd-EOB-DTPA MRI、CEUS检查。数据采用卡方检验,绘制受试者操作特征曲线(ROC曲线)用来评价Gd-EOB-DTPA MRI、CEUS诊断效能,计算曲线下面积(AUC)、敏感度、特异度及准确度。结果 52例患者共70个结节,其中54个结节诊断为SHCC,16个结节诊断为异型增生结节(DN)。SHCC、DN在MRI T1WI、T2WI、动脉期高强化、肝胆期、DWI及CEUS动脉期高增强表现中差异有统计学意义(P<0.05)。CEUS动脉期高增强、Gd-EOB-DTPA MRI肝胆期低信号及DWI高信号及诊断SHCC时AUC均分别高于T1WI低信号、T2WI高信号及动脉期高强化(P<0.05)。Gd-EOB-DTPA MRI肝胆期低信号、DWI高信号及CEUS动脉期高增强联合诊断SHCC时敏感度、特异度及准确度分别为95.5%、96.3%及96.2%。结论联合CEUS动脉期高增强、Gd-EOB-DTPA MRI肝胆期低信号和DWI高信号能够提高肝硬化背景下SHCC的诊断效能。

关键词: 肝细胞癌, Gd-EOB-DTPA MRI, 超声造影, 受试者操作特征曲线

Abstract: Objective To analyze the clinical value of Gd-EOB-DTPA enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) combined with contrast-enhanced ultrasound (CEUS) in the diagnosis of < 2 cm hepatocellular carcinoma, so-called small hepatocellular carcinoma (SHCC), on the background of liver cirrhosis. Methods Fifty-two patients (36 males and 16 females) with focal hepatic nodules (< 2 cm) having high risk of HCC with an average age of (58.6 ± 9.0) years from January 2015 to December 2019 were analyzed retrospectively. All patients had undergone Gd-EOB-DTPA MRI and CEUS. Chi-square test was used to compare the data between SHCC and dysplastic nodules (DN); receiver operating characteristic curve (ROC) curve was used to evaluate the diagnostic efficiency of Gd-EOB-DTPA MRI and CEUS. Results There were 70 nodules in 52 patients, 54 nodules diagnosed as SHCC, 16 as DN. SHCC and DN were significantly different in T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), arterial phase hyperenhancement, hepatobiliary phase, diffusion weighted imaging (DWI) of MRI and arterial phase hyperenhancement of CEUS (P<0.05). The area under the ROC curve of CEUS arterial phase hyperenhancement, Gd-EOB-DTPA MRI hepatobiliary phase low signal and DWI high signal for diagnosing SHCC were higher than that of Gd-EOB-DTPA MRI T1WI low signal, T2WI high signal and arterial phase hyperenhancement, respectively (P<0.05). For diagnosing SHCC, arterial phase hyperenhancement of CEUS combined with low signal intensity in hepatobiliary phase and high signal intensity in DWI of Gd-EOB-DTPA MRI had sensitivity of 95.5%, specificity of 96.3% and accuracy of 96.2%. Conclusion Arterial phase hyperenhancement of CEUS combined with low signal intensity in hepatobiliary phase and high signal intensity in DWI of Gd-EOB-DTPA MRI helps to improve the diagnostic efficiency of SHCC on the background of liver cirrhosis.

Key words: Hepatocellular carcinoma, Gd-EOB-DTPA enhanced magnetic resonance imaging, Contrast-enhanced ultrasonography, Receiver operating characteristic curve

陈育锋, 朱泽远, 程影, 祁良. Gd-EOB-DTPA MRI联合超声造影对肝硬化背景<2 cm肝癌的诊断[J]. 肝脏, 2021, 26(3): 273-275.

CHEN Yu-feng, ZHU Ze-yuan, CHENG Ying, QI Liang. Gd-EOB-DTPA MRI combined with contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma (< 2cm) on the background of liver cirrhosis[J]. Chinese Hepatolgy, 2021, 26(3): 273-275.

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