MRI特异性对比剂铁羧葡胺对肝脏局灶性病变检出的比较研究

目的 通过比较MR平扫、应用对比剂钆喷替酸葡甲胺（Gd—DTPA）增强MRI及MRI特异性对比剂铁羧葡胺增强MRI对肝脏局灶性病变的检出，验证铁羧葡胺在病灶检出方面的优势。方法 2003年12月至2004年7月，选择怀疑为肝脏局灶性病变的病例59例，根据相对金标准判定共133个病灶。所有病例均先行梯度回波（GRE）T1WI、去脂快速自旋回波（FSE）序列T2WI、动态梯度回波Gd—DTPA增强MRI，48h后行铁羧葡胺动态GRE增强扫描及去脂FSE T2WI与GRE TW^＊W延迟扫描。统计各序列对局灶性病变检出的敏感性。结果 铁羧葡胺延迟增强去脂FSE T2W序列、动态GRE增强扫描、GRE T2^＊W延迟增强扫描检出病灶数分别为130、115、127个；平扫GRE T1WI序列、去脂FSE T2WI检出病灶分别为84和106个；Gd—DTPA动态GRE增强检出123个病灶。对于其中44个的微小病灶（〈1cm），铁羧葡胺延迟增强去脂FSE T2WI检出率达到932％（41/44），铁羧葡胺动态增强检出率为727％（32/44），铁羧葡胺延迟增强GRE T2^＊WI检出率为886％（39/44），Gd—DTPA动态增强检出率为795％（35/44），平扫去脂FSE T2WI检出率为545％（24/44），平扫GRE T1WI检出率为34.1％（15/44）。铁羧葡胺延迟增强去脂FSE T2WI及GRE T2WI显著提高了对于微小病灶（〈1cm）的检出率，与平扫MR（包括去脂FSE T2WI和GRE T1WI）及Gd—DTPA动态增强MR相比差异有统计学意义（P〈005）。结论 铁羧葡胺延迟增强去脂FSE T2WI及GRE T2^＊WI序列优势主要为提高肝微小病灶（〈10cm）的检出率。

The comparative study of ferucarbotran enhanced MRI in detecting focal hepatic lesions

Objective To evaluate the efficacy of ferucarbotran enhanced MRI in the detection of focal hepatic lesions by means of comparison with plain and Gd-DTPA enhanced MRI. Methods Between December 2003 and July 2004, 59 consecutive patients with suspected focal hepatic lesions were undergone in study. Plain MRI(such as FSE T_2WI with fat suppression and GRE T_1WI sequences) and Gd-DTPA dynamic enhanced MRI of the liver were initially performed, then followed by ferucarbotran enhanced MRI(including GRE T_1WI , FSE T_2WI with fat suppression and GRE T_2*WI sequences) 48 hours later. The sensitivity were statistically calculated by different sequences of MRI.Results There were 130 lesions on FSE T_2WI with fat suppression,115 lesions on dynamic T_1WI GRE and 127 lesions on GRE T_2*WI respectively which were studied by ferucarbotran enhanced MRI. There were only 84 lesions on GRE T_1WI and 106 lesions on FSE T_2WI with fat suppression which were detected by pre-contrast MRI, meanwhile one hundred twenty-three lesions were found by Gd-DTPA dynamic enhanced GRE T_1WI. Among 44 micro-lesions(<1.0 cm) of all patients, the detectability were as follows: 93.2%(41/44) for ferucarbotran enhanced FSE T_2WI with fat suppression, 88.6%(39/44) for ferucarbotran enhanced GRE T_2*WI, 79.5%(35/44) for Gd-DTPA dynamic enhanced GRE T_1WI, 54.5%(24/44) for pre-contrast FSE T_2WI with fat suppression and 34.1%(15/44) for pre-contrast GRE T_1WI. Ferucarbotran-enhanced FSE T_2WI with fat suppression and GRE T_2*WI sequences had statistically significant difference with the other sequences in detecting micro-lesions (P<0.05).Conclusions Ferucarbotran enhanced FSE T_2WI with fat suppression and GRE T_2*WI sequences markedly improved the detection of the micro-lesions (<1 cm) in comparison with plain and Gd-DTPA dynamic enhanced MRI.