钆塞酸二钠增强MRI对不典型肝脓肿与单发肝转移瘤的鉴别诊断

目的 探讨钆塞酸二钠（Gd-EOB-DTPA）增强MRI对不典型肝脓肿（AHA）和单发肝转移瘤（SHM）的鉴别诊断价值。资料与方法 回顾性收集2019年9月—2023年2月河南中医药大学第一附属医院经病理证实的36例AHA和48例SHM的影像及临床资料。患者均行肝脏扩散加权成像（DWI）和Gd-EOB-DTPA增强MRI扫描。比较两组患者的影像学特征及临床指标。使用Logistic回归分析模型筛选出AHA的独立预测指标,采用受试者工作特征曲线分析各独立因素及其联合预测AHA的诊断效能。结果 AHA组多见DWI非环形高信号（33/36）、肝胆期病灶边缘非缺损区（32/36）(OR=9.308,95%CI 2.508～34.537);SHM组多见DWI靶样高信号（22/48）、肝胆期病灶边缘缺损区（36/48）(OR=24.000,95%CI 7.031～81.921;P均<0.05)。DWI非环形高信号（OR=5.467,95%CI 1.206～24.789）、肝胆期病灶边缘非缺损区（OR=18.611,95%CI 5.254～65.922）是诊断AHA的独立预测因素（P均<...     

磁共振弥散成像、非增强磁共振和多排CT对结直肠癌术后肝转移灶检出的对比分析

目的 比较磁共振扩散加权成像、非增强磁共振和多排CT对结直肠癌肝转移的诊断价值.方法 27例结直肠癌患者行肝脏磁共振扩散加权成像、非增强磁共振和多排CT检查.阅片前告知阅片者患者为结直肠癌术后,但不提供临床病史和既往影像学资料.结果 多排CT、非增强磁共振和扩散加权成像对肝转移灶的敏感性分别为72%(45/63)、76%(48/63)和93%(58/63),扩散加权成像对肝转移灶具有更高的敏感性且与多排CT或非增强MRI具有显著差异.结论 磁共振扩散加权成像对结直肠癌肝转移灶的检出率高于多排CT和非增强MRI.     

磁共振扩散加权成像对结肠癌术后肝转移灶检出的临床研究

目的:探讨磁共振扩散加权成像对结直肠癌肝转移的诊断价值。方法:27例结直肠癌患者行肝脏磁共振扩散加权成像、非增强磁共振和多层CT检查。阅片前告知阅片者患者为结直肠癌术后,但不提供临床病史和既往影像学资料。结果:多层CT、非增强磁共振和扩散加权成像对肝转移灶的敏感度分别为72%(45/63)、76%(48/63)和93%(58/63),扩散加权成像对肝转移灶具有更高的敏感度且与多层CT和非增强MRI相比,差异有显著性意义。扩散加权成像对肝转移患者敏感度最高(82%),而多层CT和非增强MRI分别为77%和66%。结论:磁共振扩散加权成像对结直肠癌肝转移灶的检出率高于多层CT和非增强MRI。     

Gd-EOB-DTPA增强3.0T MR成像:注射对比剂后10min和20min获得的肝实质期影像对于检测结直肠癌肝转移的定量及定性对照

目的定性和定量比较注射Gd-EOB-DTPA 10min和20min后3.0TMR设备上所获得的影像用于检测结直肠癌肝转移的区别。方法共48例病人(男26例,女22例;平均64岁)进行了Gd-EOB-DTPA增强MR检查,经组织病理     

肝脏血流灌注指数和血小板衍生内皮细胞生长因子在结直肠癌肝转移中的作用研究

目的 检测结直肠癌患者的肝脏血流灌注指数(DPI)和血小板衍生内皮细胞生长因子(PD-ECGF)的表达,探讨结直肠癌肝转移患者DPI及PD-ECGF变化的规律.方法 选取术前结直肠癌患者50例作为结直肠癌组(分为肝转移组22例与无肝转移组28例),以同期50例健康人作为对照组.对全体受试对象进行彩色多普勒超声检测肝脏血流状况,并由计算机计算出DPI(肝动脉血流量/全肝血流量).应用荧光实时定量PCR及免疫组化方法检测术后结直肠癌及癌旁组织标本的PD-ECGF mRNA转录水平和蛋白表达水平.结果 病理及影像学资料结果证明结直肠癌肝转移组的DPI值明显高于无肝转移组和对照组(P<0.05),准确率达100%;无肝转移组与对照组之间差异无统计学意义(P＞0.05).免疫组化及荧光实时定量PCR结果证实结直肠癌中PD-ECGF mRNA及蛋白表达水平明显高于癌旁组织(P<0.05);肝转移组明显高于无肝转移组(P<0.05).结论 DPI和PD-ECGF可作为检测结直肠癌肝转移的指标,并为结直肠癌肝转移患者的早期诊断和术后随访提供简便、有效的手段.     

钆塞酸二钠增强MRI与多期动态增强MSCT对诊断结直肠癌肝转移的比较研究

【摘要】目的：比较钆塞酸二钠（Gd-EOB-DTPA）增强MRI与多期动态增强MSCT对结直肠癌肝转移的检出能力。方法：回顾性分析64例经病理证实为结直肠癌肝转移患者（224个病灶）的Gd-EOB-DTPA增强MRI和多期动态增强MSCT影像学资料。将肝转移病灶按部位分为肝被膜下、胆管旁和肝实质病灶三组,按直径分为≤0.5cm、0.6～1.0cm、 1.1～2.0cm和>2.0cm四组。比较两种检查方法显示不同大小、不同部位结直肠癌肝转移病灶能力的差异。结果：Gd-EOB-DTPA增强MRI共检出217个病灶,检出率为96.88%（217/224）,多期动态增强MSCT共检出188个病灶,检出率为83.93% (188/224),两者检出率差异有统计学意义（P<0.001）。Gd-EOB-DTPA增强MRI对胆管旁和肝实质内病灶的检出能力高于多期动态增强MSCT（胆管旁病灶：100% vs. 0%,P=0.029;肝实质内病灶：100% vs. 88.68%,P<0.001）;两者对肝被膜下病灶的检出能力差异无统计学意义（P=1.000）。Gd-EOB-DTPA增强MRI对直径≤0.5cm和0.6～1.0cm病灶的检出能力高于多期动态增强MSCT（≤0.5cm病灶：87.50% vs. 65.00%,P=0.018;0.6～1.0cm：84.21% vs. 36.84%,P=0.007）;两者对1.1～2.0cm和>2.0cm病灶的检出能力差异无统计学意义（P=0.363、1.000）。结论：Gd-EOB-DTP增强MRI对结直肠癌肝转移的检出能力明显优于多期动态增强MSCT,特别是肝实质内、胆管周围转移和微小转移病灶。     

MR直方图预测结直肠癌肝转移化疗疗效

正摘要目的以实体瘤疗效评价标准(RECIST 1.1)为参考标准,探讨MRI直方图分析对预测结直肠癌肝转移病人化疗疗效的价值。方法 53例结直肠癌肝转移病人在化疗前进行常规MRI检查,包括扩散加权成像(b=0,500 s/mm~2)。将表观扩散系数(ADC)图、动脉期和门静脉期强化图中的最大转移灶兴趣区(ROI)以直方图形式显示,得到上述图像中最     

结直肠癌肝转移瘤周围肝实质的MRI表现:一种长期预后的潜在预测因子

正摘要钆塞酸二钠(Gd-EOB-DTPA)增强MRI在检测10 mm的结直肠癌肝转移瘤(CRLM)方面优于CT。但是,很少有研究以MRI表现来预测病人的长期预后。目的探讨     

射频消融术联合肝动脉化疗栓塞及西妥昔单抗治疗结直肠癌肝转移的疗效评价

目的 探究射频消融术(RFA)联合肝动脉栓塞化疗术(TACE)及西妥昔单抗(cetuximab)治疗结直肠癌肝转移的临床疗效.方法 回顾性分析2010年1月-2014年1月49例结直肠癌肝转移患者,分为治疗组(RFA+TACE+cetuximab)23例和对照组(TACE+cetuximab)26例,观察两组患者治疗后实体瘤疗效、1年总生存率(OS)、1年无进展生存率(PFS)及不良反应的情况.结果 治疗组的完全缓解率达到73.9％(17/23),明显优于对照组的26.9％(7/26),差异有统计学意义(P＜0.05).治疗组及对照组的OS差异无统计学意义(P＞0.05);但治疗组的1年PFS为52.2％,优于对照组的23.1％,差异有统计学意义(P＜0.05).结论 对于无法手术的结直肠癌肝转移患者,RFA联合TACE及西妥昔单抗治疗的近期疗效及1年PFS优于单纯TACE联合西妥昔单抗治疗,具有肿瘤完全坏死率高、肝内复发率低的优点.     

结直肠癌患者血清可溶性E选择素的检测及其临床意义

目的测定结直肠癌患者可溶性E选择素(sE-selectin)的血清水平并探讨其临床意义。方法采用ELISA法检测84例结直肠癌患者和30名正常人血清sE-selectin水平,随访其中54例患者,比较其手术前后血清sE-selectin水平的变化,并对结直肠癌患者sE-selectin、CEA、CA199和CA242的阳性率进行比较。结果84例结直肠癌患者血清sE-selectin阳性率为71·4%,其水平为55·21±8·98ng/ml,明显高于正常人群(17·94±5·53ng/ml,P<0·001),DukesD期患者sE-selectin水平为75·43±8·67ng/ml,显著高于A、B、C期水平(P<0·01);sE-selectin水平与年龄、性别、肿瘤部位及组织学分级无明显相关(P>0·05)。13例结直肠癌肝转移患者血清sE-selectin水平明显高于无肝转移患者(P<0·01)。结直肠癌患者术后1、12个月及12月以上血清sE-selectin水平同术前比较有显著差异(P<0·001)。sE-selectin阳性率明显高于CEA、CA199、CA242及CEA CA199 CA242联合检测的阳性率(P<0·01)。sE-selectin水平升高组较水平正常组肿瘤患者生存率显著降低(P<0·01)。结论sE-selectin在结直肠癌中阳性率较高,动态检测sE-selectin水平对于预测复发转移、评估预后具有重要临床意义,血清sE-selectin可能成为结直肠癌及其肝转移有价值的标志物。     

钆塞酸二钠增强MRI对不典型肝细胞癌和肝内胆管细胞癌的鉴别诊断价值

目的 探讨钆塞酸二钠（Gd-EOB-DTPA） 增强 MRI对最大径≤3 cm的不典型肝细胞癌（HCC）及肝内胆管细胞癌（ICC）的鉴别诊断价值。 方法 回顾性纳入经病理证实的最大径≤3 cm的不典型HCC 26例[男17例,女9例,平均年龄（56.9±11.3）岁;HCC组]及ICC 21例[男16例,女5例,平均年龄（58.2±11.6）岁;ICC组]的临床及影像资料。评估2种肿瘤平扫及Gd-EOB-DTPA动态增强MRI上影像特征,包括肿瘤最大径、病灶边缘、病灶包膜、伴远端胆管扩张情况、病灶信号是否均匀、瘤体ADC值、动脉期强化特征、瘤周血流灌注是否异常、动态强化方式及肝胆期信号特征。采用t检验及χ ²检验分析2组的临床特征和常规平扫序列、增强MRI表现的差异,采用多因素Logistic回归分析鉴别两者的预测因素。2名影像医师对2种肿瘤的平扫及增强影像诊断结果的一致性分析采用kappa检验。 结果 HCC组病人相比ICC组多有肝炎及肝硬化病史,血清肿瘤标志物甲胎蛋白（AFP）高于ICC组,而ICC组的糖类抗原199（CA-199）水平更高;常规平扫序列MRI上HCC组病灶常有包膜,而ICC组常伴远端胆管扩张且ADC值更高;增强后ICC组更多表现为动脉期边缘强化、中央逐渐强化,更易出现肝胆期靶征改变（均P<0.05）。多因素Logistic回归分析显示增强动脉期边缘强化及肝胆期靶征为鉴别诊断HCC和ICC的重要预测征象。2名影像医师诊断一致性良好（κ=0.837,P<0.001)。 结论 Gd-EOB-DTPA 增强MRI肝胆期靶征和动脉期边缘强化对最大径≤3 cm的不典型HCC及ICC有重要鉴别诊断价值,可为治疗方案提供参考。     

Ring-like enhancement of focal nodular hyperplasia with hepatobiliary-phase Gd-EOB-DTPA-enhanced magnetic resonance imaging: radiological-pathological correlation

We report a case of focal nodular hyperplasia in a patient for whom gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and histological analysis results were available. Dynamic contrast-enhanced computed tomography showed a well-defined hypervascular lesion 14 mm in diameter with no visible central scars. Gd-EOB-DTPA-enhanced MRI demonstrated strong peripheral enhancement of the lesion during the hepatobiliary phase, resulting in ring-like enhancement. The pathology examination revealed that the lesion was focal nodular hyperplasia (FNH). Immunohistochemistry showed positive expression of OATP8 in the hepatocytes in the peripheral areas of the lesion, whereas expression of OATP8 was lacking in hepatocytes surrounding the central radiating scar. Ring-like enhancement during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may be an important clue for the diagnosis of small FNH.     

Chronological evaluation of liver enhancement in patients with chronic liver disease at Gd-EOB-DTPA-enhanced 3-T MR imaging: does liver function correlate with enhancement?

Purpose  

To investigate the chronological relationship between scan delay and liver enhancement for the hepatobiliary phase on Gd-EOB-DTPA-enhanced MRI and evaluate the effects of liver function on liver enhancement.     

关于钆塞酸二钠及钆喷酸葡胺增强MRI对肝癌诊断效能的1∶1匹配的病例对照研究

目的 通过1∶1匹配的病例对照研究,比较钆塞酸二钠(Gd-EOB-DTPA)和钆喷酸葡胺(Gd-DTPA)增强MRI对肝癌(HCC)的诊断效能,并且明确Gd-EOB-DTPA增强MRI的肝胆期是否具有补偿作用.方法 搜集行Gd-EOB-DTPA以及Gd-DTPA增强MRI检查且有肝硬化、存在肝占位性病变的患者,按年龄±...     

Incidence for progression of hypervascular HCC in hypovascular hepatic nodules showing hyperintensity on gadoxetic acid-enhanced hepatobiliary phase in patients with chronic liver diseases

Purpose

The purpose of this study was to elucidate the incidence and risk factors for the progression of hyperintense nodules, observed in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI), to hypervascular hepatocellular carcinoma (HCC).

Materials and methods

Hypovascular nodules (n = 157) showing hyperintensity in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were examined in 41 patients. All patients underwent computed tomography (CT) during hepatic arteriography and CT during arterial portography within one month of Gd-EOB-DTPA-enhanced MRI. The incidence of progression to hypervascular or classical HCC was calculated using the Kaplan–Meier method.

Results

Tumor size was determined by univariate and multivariate analysis to be an important risk factor of hypervascularization (p = 0.041, odds ratio 1.135). The cumulative incidences of hypervascularization in hypovascular nodules showing hyperintensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were 2.4, 4.5, and 6.2 % at 12, 24, and 36 months, respectively. The incidence of hypervascularization was significantly increased in nodules >10 mm in diameter (p = 0.00035).

Conclusion

In patients with chronic liver disease, hypovascular nodules presenting as hyperintense in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI and >10 mm in diameter have malignant potential for progression to hypervascular HCC and require careful management.     

Risk of hypervascularization in small hypovascular hepatic nodules showing hypointense in the hepatobiliary phase of gadoxetic acid-enhanced MRI in patients with chronic liver disease

Purpose

The purpose of this study was to elucidate the incidence and risk factors for the progression of hypointense nodules observed in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) of hypervascular hepatocellular carcinoma (HCC).

Materials and methods

Hypovascular nodules (112) showing hypointensity in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were examined in 54 patients. All patients underwent computed tomography during hepatic arteriography and computed tomography during arterial portography (CTAP) within a month after Gd-EOB-DTPA-enhanced MRI. According to the tumor size, 112 nodules were divided into two groups: those >10?mm in diameter (group A, n?=?39) and those ??10?mm in diameter (group B, n?=?73). The incidence of progression to hypervascular HCC was calculated using the Kaplan-Meier method.

Results

The incidence of hypervascularization was significantly higher in group A nodules than in group B nodules (p?<?0.0001). Tumor size (p?<?0.0001) and hypoattenuation in CTAP (p?=?0.0004) showed significant correlation with hypervascularization.

Conclusion

Hypointense nodules observed in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI with diameters of >10?mm had a high probability of hypervascularization.     

MRI扩散加权成像在非小细胞肺癌靶向治疗早期疗效评价中的应用价值

目的评价磁共振扩散加权成像(MRI-diffusion weighted imaging,MRI-DWI)在非小细胞肺癌靶向治疗早期疗效评价中的应用价值。 方法选择32例病理证实非小细胞肺癌患者,于治疗前、1周期靶向治疗后行胸部常规MRI检查、DWI检查及CT增强检查,以第2周期靶向治疗后相对于治疗前的肿瘤最大径变化率为标准,将患者分为有效组（19例）和无效组（13例）,比较两组治疗前后肿瘤表观扩散系数(ADC)值及最大径的差异。同时比较MRI-DWI与增强CT对肿瘤及阻塞性肺不张的显像效果。 结果肿瘤最大径在两组内不同时间及组间的差异均无统计学意义（P>0.05）。第1周期靶向治疗后,有效组肿瘤平均ADC值明显升高（×10^-3 mm²/s：1.48±0.23 vs. 1.23±0.21,t=-15.45,P<0.01）,而无效组治疗后ADC值变化不大（×10^-3 mm²/s：1.20±0.27 vs.1.15±0.32,t=-1.69,P>0.05）,并且有效组ADC值的升高率明显高于无效组（%：17.7±5.7 vs. 4.6±2.1,t=6.72,P<0.01）。CT图像可显示清楚肿瘤与不张肺组织边界6例（37.5%）,MRI-DWI图像可显示肿瘤与肺不张组织边界13例（81.3%）,高于CT图像,差异有统计学意义（χ²=6.35,P<0.05）。 结论MRI-DWI较增强CT可更清晰地显示肺不张与肺肿瘤边界,便于肿瘤大小测量及疗效评估,ADC值可以对非小细胞肺癌靶向治疗疗效做出早期监测。     

钆塞酸二钠增强MRI肝胆期高信号病变影像表现与特征分析

目的 探讨钆塞酸二钠（Gd-EOB-DTPA）增强MRI肝胆期高信号病变的影像学特征并进行分型。 方法 回顾性纳入经手术病理或典型影像表现及临床随访证实为肝脏局灶性病变的病人124例,平均年龄（55.1±15.8）岁。分析肝脏局灶性病变124个,包括肝细胞癌（HCC）52个、胆管细胞癌（ICC）7个、混合型肝细胞癌-胆管癌（cHCC-CC）4个、转移瘤（HM）6个、局灶性结节增生（FNH）及FNH样变42个、肝腺瘤（HCA）2个、异型增生结节（DN）5个、肝海绵状血管瘤（CHL）6个。所有病人均行肝脏Gd-EOB-DTPA增强MRI检查,观察分析肝胆期高信号病变特征并对其进行分型。同一病变中不同分型间占比的比较采用Fisher确切概率检验。计算肝胆期病灶-肝脏信号强度比（LLR）,不同病变间LLR的比较采用Kruskal-Wallis检验。 结果 HCC、ICC、HM、FNH/FNH样变和DN病变中不同分型间占比的差异均有统计学意义（均P<0.05）。HCC病灶中28个可见包膜（53.85%）,各分型中Ⅱb型最多（23/52,44.23%）;ICC病灶中Ⅱa型和Ⅲ型最多（均为3/7,42.86%）;HM病灶中Ⅱa型最多（4/6,66.66%）,且均为胃肠道转移瘤;FNH/FNH样变中Ⅳa型最多（32/42,76.19%）;DN病灶中Ⅰa型最多（4/5,80.00%）。肝胆期不同高信号的病变间LLR的差异有统计学意义（P<0.05）,HCC的LLR低于FNH/FNH样变（P<0.05）。 结论 Gd-EOB-DTPA增强MRI肝胆期高信号病变的影像特征分型对肝脏局灶性病变的诊断具有一定价值。     

DCE-MRI减影技术及DWI序列在原发性肝癌局部介入术后评估的应用研究

目的探讨磁共振动态增强减影技术及DWI序列在原发性肝癌经局部介入治疗术后疗效评估中的应用价值。方法收集56例经临床或病理证实为原发性肝癌的患者,同时满足1)接受过射频消融、微波消融、动脉内碘油栓塞等局部介入治疗术后≥6个月;2)治疗后病灶MRI表现为平扫T1高信号,且病灶直径≥1cm。共纳入符合标准的74个病灶,根据mRECIST标准,将所有病灶分为完全坏死组(42个病灶)和复发残留组(32个病灶)。由两位腹部影像诊断医师对MRI常规动态增强、动态增强减影及DWI(联合ADC)图像分别进行肉眼分析并对疗效判断的信心度进行评分,采用方差分析比较三种技术医师信心度水平差异;分别计算病灶在MRI常规动态增强与增强减影后动脉期、静脉期图像上的对比信噪比(CNR),采用t检验比较减影前后差异;测量所有病灶ADC值并对比完全坏死组与复发残留组之间差异。P<0.05为差异有统计学意义。结果完全坏死组1)诊断医师对常规动态增强、动态增强减影、DWI(联合ADC)三种技术肉眼判断肿瘤完全性坏死的信心度评分无显著差异;2)MRI动态增强动脉期减影前、后病灶CNR值无显著差异;静脉期减影后病灶CNR值明显大于减影前。复发残留组1)三种技术判断病灶内仍有活性肿瘤组织残留或复发的医师信心度评分由高到低为动态增强减影>常规动态增强>DWI(联合ADC);2)MRI动态增强动脉期、静脉期减影后病灶CNR值均显著大于减影前。复发残留组病灶平均ADC值明显低于完全性坏死组。结论与常规动态增强相比,减影技术结合DWI及ADC图像的定量分析,可以更加准确评估原发性肝癌局部治疗疗效。     

Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions

A multicenter study has been employed to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). One hundred and sixty-nine patients with hepatic lesions eligible for surgery underwent Gd-EOB-DTPA-enhanced MRI as well as CT within 6 weeks. Pathologic evaluation of the liver specimen combined with intraoperative ultrasound established the SOR. Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: −4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT.