摘要
目的探讨钆塞酸二钠磁共振成像(magnetic resonance imaging,MRI)表观弥散系数(apparent diffusion coefficient,ADC)联合增强血管期病灶最大强化率(maximum enhancement rate,ER_(max))鉴别诊断肝硬化背景下不典型增生结节(dysplastic nodule,DN)与小肝癌(small hepatocellular carcinoma,sHCC)的价值。方法回顾性分析2016年1月至2019年9月在南京市第二医院就诊、具有肝硬化背景并经术后病理或肝组织活检确诊的33例sHCC和24例DN患者的MRI平扫+扩散加权成像(diffusion weighted imaging,DWI)+钆塞酸二钠增强图像。对患者图像进行编号,采用两种方法盲法阅片。首先使用方法一(MRI平扫+DWI+增强血管期)进行诊断,打乱顺序后相隔2周再使用方法二(方法一+增强肝胆期)进行诊断,计算两种方法的敏感性、特异度和正确率。测量两组患者病灶ADC值和ER_(max),采用受试者工作特征(receiver operator characteristic,ROC)曲线分析ADC值、ER_(max)及ADC+ER_(max)的鉴别诊断效能。结果方法二的敏感性(90.9%vs 69.7%)和正确率(89.5%vs 71.9%)均显著高于方法一(χ~2=4.694,P=0.030;χ~2=5.632,P=0.018),特异度(87.5%vs75.0%)差异无统计学意义(χ~2=1.231,P=0.267)。sHCC患者病灶ADC值显著低于DN患者[(1.24±0.21)×10^(-3) mm^2/s vs (1.54±0.19)×10^(-3) mm^2/s],ER_(max)显著高于DN患者[(79.03±18.22)%vs(49.52±15.16)%],差异均有统计学意义(t=-5.835,P <0.001;t=6.620,P <0.001)。病灶ADC值、ER_(max)及ADC+ER_(max)鉴别sHCC和DN的曲线下面积分别为0.851、0.895和0.950,约登指数分别为0.543、0.657和0.771。ADC+ER_(max)联合鉴别诊断sHCC的特异度(97.1%vs 75.0%)显著高于方法一(χ~2=13.917,P<0.001),敏感性(80.0%vs 69.7%)差异无统计学意义(χ~2=1.508,P=0.219);与方法二相比,敏感性(80.0%vs 90.9%)和特异度(97.1%vs 87.5%)差异均无统计学意义(χ~2=2.065,P=0.151;χ~2=3.794,P=0.051)。结论 MRI钆塞酸二钠增强肝胆期图像有利于提高sHCC的诊断效能。对于无肝细胞特异性对比剂的医疗单位,采用ADC值联合血管期强化的ER_(max)可达到与之相近的鉴别诊断效能。
Objective To evaluate the value of apparent diffusion coefficient(ADC)values combined with maximum enhancement rate(ERmax)in gadoxetate disodiummagnetic resonance imaging(MRI)on identifying dysplastic nodule(DN)and small hepatocellular carcinoma(sHCC)in the context of liver cirrhosis.Methods The MRI+diffusion weighted imaging(DWI)+gadoxetate disodiumenhanced images of patients with sHCC(33 cases)and patients with DN(24 cases)who were confirmed by pathology or biopsy in the Second Hospital of Nanjing from January 2016 to September 2019 were retrospectively analyzed.The patients were all in the context of liver cirrhosis.The images of patients were numbered and read blindly by two methods.Firstly,method 1(non-enhanced MRI+DWI+enhanced vascular phases images)was used to diagnose,secondly,the order of the images were shuffled and after two weeks method 2(method 1+enhanced hepatobiliary phase images)was used to diagnose.The sensitivity,specificity and accuracy of the two methods were calculated.ADC value and ERmax of lesions in the two groups were measured.The receiver operating characteristic(ROC)curve was used to analyze the differential diagnostic efficacy of ADC value,ERmax and ADC+ERmax.Results The sensitivity(90.9%vs 69.7%)and accuracy(89.5%vs 71.9%)of method 2 were significantly higher than those of method 1(χ2=4.694,P=0.030;χ2=5.632,P=0.018),the differences of specificity(87.5%vs 75.0%)was not statistically significant(χ2=1.231,P=0.267).ADC value[(1.24±0.21)×10-3 mm2/s vs(1.54±0.19)×10-3 mm2/s]of lesions in patients with sHCC was lower and ERmax[(79.03±18.22)%vs(49.52±15.16)%]was higher than those with DN,and the differences were statistically significant(t=-5.835,P<0.001;t=6.620,P<0.001).The area under the curve of ADC value,ERmax and ADC+ERmax in the identification of sHCC and DN were 0.851,0.895 and 0.950,and the Youden index were 0.543,0.657 and 0.771,respectively.The specificity of ADC+ERmax in the identification of sHCC was significantly higher than that of method 1(97.1%vs 75.0%,χ2=13.917,P<0.001),and the difference of sensitivity was not statistically significant(80.0%vs 69.7%,χ2=1.508,P=0.219).There were no significant differences in sensitivity(80.0%vs 90.9%)and specificity(97.1%vs 87.5%)compared with method 2(χ2=2.065,P=0.151;χ2=3.794,P=0.051).Conclusions The gadoxetate disodium hepatobiliary phase images of enhanced MRI is beneficial to increase the diagnostic efficiency of sHCC.ADC combined ERmax of enhanced vascular phases MRI can achieve the similar diagnostic efficacy for hospitals without hepatocellular specific contrast agents.
作者
田玉亭
李代欣
付志浩
叶伟
许传军
Tian Yuting;Li Daixin;Fu Zhihao;Ye Wei;Xu Chuanjun(Department of Radiology,the Second Hospital of Nanjing,Nanjing 210003,China;Department of Hepatopathy,the Second Hospital of Nanjing,Nanjing 210003,China)
出处
《中国肝脏病杂志（电子版）》
CAS
2020年第4期17-22,共6页
Chinese Journal of Liver Diseases：Electronic Version
基金
南京市医学科技发展项目(YKK17173)。
关键词
磁共振
钆塞酸二钠
表观弥散系数
小肝细胞癌
不典型增生结节
Magnetic resonance
Gadoxetate disodium
Apparent diffusion coefficient
Small hepatocellular carcinoma
Dysplastic nodule
