摘要
目的评价Gd-EOB-DTPA MRI检查中肝胆管期对定期复查肝硬化患者检出小肝癌的临床诊断价值。方法 33例肝硬化患者分别进行超声增强检查、Gd-EOB-DTPA增强MRI检查和64排螺旋CT检查共检测出48枚肝脏小结节（直径为10~30 mm）,全程使用盲法,以2005年美国肝脏病研究协会标准为诊断标准。结果 48枚肝脏小结节中,38枚（79.2%）被诊断为肝细胞癌,MRI检查中30枚（78.9%）符合典型血管强化征象（快进快出）,CT检查有22枚（57.9%）,增强超声检查有17枚（44.7%）。所有38枚肝细胞癌和3枚良性结节在肝胆管期显示低信号（敏感性100%,特异性70%,阳性预测值93%,阴性预测值100%,阳性似然比3.33,阴性似然比0）。38枚肝细胞癌结节中,有7枚在各影像学检查中均不显示典型血管强化征象,有8枚（21.1%）显示为门静脉期廓清,MR肝胆管期低信号征象,此征象未见于良性病变中。结论 Gd-EOB-DTPA MRI检查能提高定期复查的肝硬化患者小肝癌检出的敏感性。门静脉期/静脉期低信号,肝胆管期低信号可以作为MRI最新诊断征象,特别是对乏血供肝细胞癌的检出。
Objective To evaluate the contribution of the hepatobiliary phase of Gd-EOB-DTPA MR in the diagnosis of small hepatocellular carcinoma（HCC） in cirrhotic patients under surveillance.Methods Between April 2012 and April2014; 48 consecutive small（10- 30 mm） liver nodules were detected in 33 patients,who prospectively underwent contrast-enhanced ultrasound（CEUS）,Gd-EOB-DTPA-enhanced MR and helicalcomputed tomography（CT） in a blind study.The diagnosis of HCC was established according to AASLD 2005 criteria.Results Of the 48 nodules,38（79.2%）were diagnosed as HCC.The typical vascular pattern（arterial hypervascularization and venous / late washout） was detected in 30（78.9%） of the HCC nodules by MR,22（57.9%） by CT and 17（44.7%） by CEUS.Hypointensity during the MR hepatobiliary phase was observed in all HCC nodules and in 3 non-malignant nodules（sensitivity 100%,specificity70%,positive predictive value 93%,negative predictive value 100%,positive likelihood ratio 3.33,negative likelihood ratio 0）.Eight（21.1%） of the 38 HCC nodules,7 of which lacked the typical vascular features at any of the imaging modalities,they showed washout in the portal / venous phase and hypointensity in the hepatobiliary phase at MRI,while this pattern was not detected in any non-malignant lesion.Conclusion Gadoxetic acid magnetic resonance imaging may enhance the sensitivity of the noninvasive diagnosis of small hepatocellular carcinoma nodules in cirrhotic patients under surveillance.Double hypointensity in the portal/venous and hepatobiliary phases could be considered a new magnetic resonance pattern,highly suggestive of hypovascular hepatocellular carcinoma.
出处
《临床放射学杂志》
CSCD
北大核心
2016年第6期951-955,共5页
Journal of Clinical Radiology
关键词
钆塞酸二钠
磁共振成像
肝胆管期
小肝癌
Gd-EOB-DTPA
Magnetic resonance imaging
Hepatobiliary phase
Small hepatocellular carcinoma
