钆塞酸二钠增强MRI评估全肝及各肝段肝功能

目的 评价采用乳腺CEUS预测模型诊断乳腺恶性病灶的观察者一致性。方法 收集多中心共953例接受超声和CEUS检查的乳腺单发结节患者。本课题组由初始组（各医院1名低年资医师）、检查者组（各医院1~2名具有2年以上CEUS检查经验的医师）、研究组（四川省医学科学院四川省人民医院2名高年资医师）及交叉盲读组（各医院1~2名副主任医师或主任医师）构成。首先由初始组及检查者组根据乳腺影像报告和数据系统（BI-RADS）对病灶进行分类，其次由交叉盲读组和研究组采用乳腺CEUS预测模型再次进行BI-RADS分类。以病理结果为金标准，计算4组诊断乳腺恶性病灶的效能；分析观察者间诊断乳腺恶性病灶的一致性。结果 953例中，病理证实良性病灶451例（451/953，47.32%），恶性病灶435例（435/953，45.65%），癌前病变67例（67/953，7.03%）。初始组、检查者组、研究组及交叉盲读组诊断乳腺恶性病灶的准确率分别为71.67%（683/953）、74.92%（714/953）、80.17%（764/953）及83.42%（795/953）。初始组与检查者组诊断乳腺恶性病灶的一致性较好（Kappa=0.82，P<0.001），与研究组及交叉盲读组的一致性中等（Kappa=0.56、0.41，P均<0.001）；检查者组与研究组、交叉盲读组的一致性均为中等（Kappa=0.68、0.51，P均<0.001）；研究组与交叉盲读组的一致性中等（Kappa=0.74，P<0.001）。结论 不同观察者采用乳腺CEUS预测模型诊断乳腺恶性病灶的一致性一般。

Gd-EOB-DTPA enhanced MRI in assessing whole liver and segmental liver function

Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI in assessing liver reserve function in patients with normal liver function and abnormal liver function. Methods Totally 99 hepatitis B cirrhosis patients with abnormal liver function were classified into the following three groups, i.e. Child-Pugh A group (n=48), Child-Pugh B group (n=40), Child-Pugh C group (n=11), while 21 patients without chronic liver disease were taken as normal liver function group. All patients underwent Gd-EOB-DTPA enhanced MRI. At 3 min, 10 min and 20 min after intravenous administration of Gd-EOB-DTPA, the relative enhancement (RE) of whole liver and liver segments (S1-S8) was calculated, and the differences of liver RE were compared among different liver function groups and liver segments. Results At 3 min, 10 min and 20 min after intravenous administration of Gd-EOB-DTPA, the differences of whole liver RE and segmental liver RE among the Child-Pugh A group, Child-Pugh B group, Child-Pugh C group and normal liver function group were statistically different (all P<0.05). At 3 min, 10 min and 20 min after injection, RE of normal liver function group and Child-Pugh A group was significantly different among different liver segments (S1-S8). At 10 min and 20 min after injection, RE of Child-Pugh B group was significantly different among different liver segments, while at 20 min after injection, RE of Child-Pugh C group was significantly different among different liver segments. Conclusion Gd-EOB-DTPA enhanced MRI can accurately assess whole liver and segmental liver function.