钆塞酸二钠增强MR与增强CT诊断肝脏局灶性病变效能对比研究*

目的 探讨应用钆塞酸二钠增强 MR检查对肝脏局灶性病变的诊断效能。方法 2015年6月~2017年6月我院诊治的肝脏局灶性病变患者47例,行无肝胆期和有肝胆期钆塞酸二钠增强 MR和增强 CT检查,行肝穿刺活组织病理学检查,以此为金标准,计算各检查方法的诊断效能。结果 在47例肝脏局灶性病变患者中,病变大小为0.7~6.2 cm （2.1±0.8） cm。经病理学检查诊断为胆管细胞癌15例,胆管囊腺癌1例,结肠癌肝转移8例,直肠癌肝转移3例和肝血管瘤5例,局灶性结节性增生8例,肝硬化结节4例,脂肪瘤2例,腺瘤1例;有肝胆期钆塞酸二钠增强 MRI诊断的敏感度为88.9%,特异度为80.0%,准确度为85.1%,显著高于无肝胆期钆塞酸二钠增强 MRI的60.0%、61.7%和63.0%或增强 CT检查的45.0%、48.9%和51.9%,差异有统计学意义（P<0.05）。结论 有肝胆期钆塞酸二钠增强 MRI检查有利于提高对肝脏局灶性病变的临床定性诊断,值得进一步验证。

Efficacy of gadolinium disodium enhanced MR in the diagnosis of patients with focal liver lesions

Objective To investigate the efficacy of gadolinium disodium enhanced MR in the diagnosis of patients with focal liver lesions（FLL）. Methods 47 consecutive patients with FLL were selected in our hospital between June 2015 and June 2017. The liver biopsies were performed and the diagnoses were confirmed by histopathology. All patients underwent disodium gadoxate enhanced MR with or without hepatobiliary phase,and enhanced CT scan. The independent blind analysis was performed by radiologists based on the five-point scale. Results The lesion size was 0.7~6.2 cm（2.1±0.8） cm in the 47 patients with FLL,and the pathological examination demonstrated cholangiocarcinoma in 15,biliary cystadenocarcinoma in 1,metastases from colorectal cancer in 11,and hepatic hemagioma in 5,hepatic focal nodular hyperplasia in 8,nodule with underlying liver cirrhosis in 4,lipoma in 2 and adenoma in 1;the sensitivity,specificity and accuracy by MRI with hepatobiliary phase scan were 88.9%,80.0%and 85.1%,much higher than 60.0%,61.7% and 63.0% by MRI without hepatobiliary phase scan or 45.0%,48.9% and 51.9% by CT scan,respectively（P<0.05）. Conclusion The application of gadolinium-disulfonate-enhanced MR scan is beneficial for the qualitative diagnosis of patients with FLL,which warrants further investigation.