肝硬变相关结节Gd-EOB-DTPA增强磁共振成像初步研究

目的探索钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像在鉴别肝硬变相关结节中的应用价值。方法对2011年11月至2013年1月期间前瞻性纳入的19例肝硬变合并肝占位性病变患者进行Gd-EOB-DTPA增强磁共振检查,肝胆期为造影剂注射后20 min。将患者的图像分成2组进行诊断分析：A组,平扫和动态增强图像;B组,平扫、动态增强及肝胆期图像。采用圆形感兴趣区测量肝胆期病灶、背景肝信号强度及背景噪声标准差,计算病灶信噪比（SNR）和对比信噪比（CNR）。结果 19例患者共发现25个肝肿瘤,包括18个肝细胞性肝癌（HCC）,7个再生结节（RN）或不典型增生结节（DN）。肿瘤直径0.6～3.2 cm,平均1.3 cm。16个HCC病灶在肝胆期表现为相对于背景肝实质的低信号,2个表现为高信号;有5个HCC病灶发生坏死囊变,坏死区在动脉期无强化,在肝胆期片絮状强化。6个RN或DN在肝胆期表现为相对于背景肝实质的高信号,1个表现为等信号。A组图像和B组图像的诊断准确率分别为80.0%（20/25）和92.0%（23/25）。肝胆期RN或DN的SNR值为132.90±17.21,HCC为114.35±19.27;其CNR值为19.47±8.20,HCC为112.15±33.52。结论 Gd-EOB-DTPA增强肝胆期成像能提高肝硬变相关结节的诊断和鉴别诊断效能,有助于制定更精确和更合理的治疗方案。

Preliminary Study of Gd-EOB-DTPA Enhanced Magnetic Resonance Imaging for Cirrhosis-Related Nodules

Objective To explore the clinical value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid（Gd-EOB-DTPA） enhanced magnetic resonance（MR） imaging for cirrhosis-related nodules.？Methods Nineteen patients who were suspected cirrhosis with lesions of liver were prospectively included for Gd-EOB-DTPA enhanced MR imaging test between Nov.2011 and Jan.2013.The hepatobiliary phase（HBP） images were taken in 20 minutes after agents＇ injection.The images were diagnosed independently in two groups： group A,including the plain phase and dynamic phase images;group B,including plain phase,dynamic phase,and HBP phase images.The signal intensity（SI） of lesions in HBP images,background liver SI,and background noise standard deviation were measured by using a circular region of interest,then the lesion signal to noise ratio（SNR） and contrast signal to noise ratio（CNR） were calculated.Results Nineteen patients had 25 tumors in all,including 18 hepatocelluar carcinoma（HCC） and 7 regenerative nodule（RN） or dysplastic nodule（DN）,with the diameter ranged from 0.6 cm to 3.2 cm（average 1.3 cm）. Sixteen HCC manifested hypo SI relative to the normal liver,while 2 HCC manifested hyper SI at HBP.Five HCC had cystic necrosis with the necrotic area,and there were no enhancement in artery phase,while performed flocculent enhancement at HBP.Six RN or DN showed hyper SI while another 1 showed iso SI to background liver at HBP.The diagnostic accuracy rates of group A and group B were 80.0%（20/25） and 92.0%（23/25）.SNR of RN or DN at HBP was 132.90±17.21,and of HCC was 114.35±19.27,while the CNR of RN or DN was 19.47±8.20,and of HCC was 112.15±33.52.Conclusion？Gd-EOB-DTPA enhanced MR imaging can improve the diagnosis capacity of cirrhosis-related nodules,so as to develop more accurate and reasonable treatment options.