钆塞酸二钠增强磁共振扫描诊断肝脏局灶性病变研究*

目的 通过与手术后组织病理学诊断结果比较,观察钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）对肝脏局灶性病变（FLL）的诊断价值。方法 我院收治的FLL患者68例,接受Gd-EOB-DTPA增强MRI检查,与术后组织病理学诊断比较检查结果的正确性。结果 68例FLL患者经术后组织病理学检查诊断为肝细胞癌36例,肝内胆管细胞癌6例,混合型肝癌8例,肝局灶性结节性增生12例,肝血管平滑肌脂肪瘤4例,非FLL 2例,而Gd-EOB-DTPA增强MRI诊断FLL 64例,其中肝细胞癌37例,肝内胆管细胞癌7例,混合型肝癌4例,肝局灶性结节性增生14例,肝血管平滑肌脂肪瘤2例,非FLL 4例。增强MRI诊断FLL的Kappa值为0.7,其灵敏度为97.1%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为50.0%。结论 采取Gd-EOB-DTPA增强MRI检查对FLL诊断具有较高的灵敏度和特异度,临床应重视其诊断价值。

Enhanced magnetic resonance imaging by gadolinium disodium sebacate in diagnosis of patients with focal liver lesions

Objective This study was aimed to investigate the enhanced magnetic resonance imaging(MRI) by gadolinium disodium sebacate （Gd-EOB-DTPA） in diagnosis of patients with focal liver lesions （FLL）.Methods A prospective study was conducted on 68 patients with suspected FLL by ultrasound and/or CT scan,and all the patients accepted Gd-EOB-DTPA enhanced MRI scan. The diagnosis of MRI was reevaluated by post-operational histopathological examination.Results The liver histopathological examination showed that hepatocullular carcinoma（HCC） in 36,intrahepatic cholangiocarcinoma in 6,mixed liver carcinoma in 8,hepatic focal nodular hyperplasia in 12,hepatic vascular leiomyolipoma in 4 and non-FLL in 2,while the enhanced MRI demonstrated that HCC in 37,intrahepatic cholangiocarcinoma in 7,mixed liver carcinoma in 4,hepatic focal nodular hyperplasia in 14,hepatic vascular leiomyolipoma in 2 and non-FLL in 4;the Kappa was 0.7 when the FLLs were diagnosed by MRI,with the sensitivity of 97.1%,specificity of 100.0%,positive predicting value of 100.0% and negative predicting value of 50.0%. Conclusion The application of MRI intensified by Gd-EOB-DTPA enhancement might be helpful in diagnosis of patients with FLL,which needs further validation in clinical practice.