普美显对肝脏动脉期一过性强化灶与小肝癌检出的研究及与钆喷葡胺的比较研究

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摘要目的：比较肝细胞特异性对比剂普美显与非特异性细胞外间隙对比剂钆喷葡胺（Gd-DTPA）对肝脏动脉期一过性强化灶（Transient hepatic parenchymal enhancement，THPE）与小肝癌（Small hepatocelluar carcinoma，SHCC）鉴别诊断的能力。同时分析THPE及SHCC的形态、信号特征及应用两种对比剂的强化特征。方法：由两名影像医师共同对46名肝硬化患者的58个肝内局限性动脉期强化灶进行分析。主要分析在分别应用非特异性细胞外间隙对比剂Gd-DTPA及肝细胞特异性对比剂普美显（Gd-EOB-DTPA）的情况下各强化灶的信号、形态特征，以及增强扫描时强化方式的差别，进而综合判断病灶的性质。以手术或穿刺病理结果、介入血管造影或6月以上随诊观察等指标作为金标准，回顾性分析比较两种对比剂对于肝脏THPE和SHCC的诊断及鉴别能力。统计学方法采用卡方检验，比较THPE与SHCC在形态、位置、信号及强化方式上的差异；比较THPE的强化方式在应用两种对比剂时是否存在差异；比较SHCC的强化方式在应用两种对比剂时是否存在差异。分别比较研究总体58个肝内局限性动脉期强化灶组、36个结节状肝内局限性动脉期强化灶组和23个最大径＜1 cm的肝内局限性动脉期强化灶组，应用两种对比剂诊断的灵敏度、特异度，计算ROC曲线下面积，从而比较两种对比剂的诊断效能。P＜0.05为差异具有统计学意义。39例THPE中，33例经随诊6月得到确认，6例经介入血管造影得到确认。19例SHCC，10例由手术后病理得到证实，1例经皮肝脏穿刺活检并结合血管造影得到确认，另有8例由血管造影结合AFP指标得到证实。结果：在不同分组下，普美显的灵敏度、特异度及ROC曲线下面积均高于钆喷葡胺。THPE与SHCC在形态、位置、信号、强化方式上存在差异（P＜0.05）。THPE的强化方式在应用两种对比剂时无统计学差异（P＞0.05），SHCC的强化方式在应用两种对比剂时亦无统计学差异（P＞0.05）。结论：①MRI诊断中，THPE与SHCC在形态、信号、位置及强化方式上存在差异；THPE的强化方式在应用两种对比剂时无明显差异；SHCC的强化方式在应用两种对比剂时也无明显差异。②磁共振肝胆细胞特异性对比剂Gd-EOB-DTPA，有助于THPE与SHCC的诊断及鉴别，其诊断能力较Gd-DTPA更佳。

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	王艾博1
	罗佳文1
	边杰1
	刘军2
	陈宏海1
	翟方兵1
	刘亚洁1
	于传文1
	张喜友1

关键词 ：肝肿瘤, 磁共振成像

Abstract：Objective: To compare the ability of hepatocyte specific contrast agent Gd-EOB-DTPA with non-specific extracellular contrast agent Gd-DTPA in differential diagnosis of transient hepatic parenchymal enhancement(THPE) and small hepatocelluar carcinoma(small HCC). And to analyze the lesion shape, signal intensity, and enhancement pattern with two agents. Methods: Two radiologists analyzed the imaging characteristics of 58 focal liver lesions(FLL) from 46 patients with cirrhosis. The analysis focused on morphology, signal intensity and the patterns of enhancement in different phases with Gd-DTPA and Gd-EOB-DTPA respectively, and then the property of each focal liver lesion was inferred and compared with the final results. A retrospective analysis about the ability of two contrast mediums in detection and differential diagnosis of THPE and small HCC was performed with pathologic findings, angiography or follow-up over 6 months as reference and gold standard. The Chi-square test was used for comparisons of shape, location, signal intensity and pattern of enhancement between THPE and small HCC, comparison of enhancement pattern of THPE with the two MRI contrast agents, and comparison of enhancement pattern of small HCC with the two MRI contrast agents. Sensitivities, specificities and AUCs(area under curve) of ROCs of the two agents were figured out in the groups of total 58 FLL, 36 nodular FLL and 23 FLL whose maximum diameter＜1 cm, respectively, and thus calculating their diagnostic performance. Significance was set at P＜0.05. Among 39 THPEs, there were 33 cases confirmed by 6 months’ following up, and others were confirmed by angiography. Among 19 small HCCs, 10 cases were confirmed by postoperative pathology, 1 case was identified by percutaneous biopsy and angiography, and other 8 cases were confirmed by combining gangiography and AFP. Results: In different groups, the sensitivity, specificity and the AUC of Gd-EOB-DTPA were all higher than those of Gd-DTPA. Significant differences in shape, location, signal intensity and patterns of enhancement were observed between THPE and small HCC(P＜0.05). The patterns of enhancement of THPE with two agents showed no difference(P＞0.05), and the patterns of enhancement of small HCC with two agents showed no difference too. Conclusion: ①In magnetic resonance imaging(MRI), there are significant differences in shape, signal intensity, location and patterns of enhancement between THPE and small HCC, while the two MRI contrast agents show no statistical difference in the enhancement pattern of all focal liver lesions. ②Gd-EOB-DTPA has more advantages in distinguishing THPE from small HCC so it has a higher diagnostic performance than traditional contrast agent.

Key words： Liver neoplasms Magnetic resonance imaging

收稿日期: 2016-04-08

PACS:	Ｒ735.7
	Ｒ445.2

通讯作者: 罗佳文，大连医科大学附属第二医院放射科，116000。E-mail：kaoyan2006succeed@163.com

作者简介: 王艾博（1989-），男，辽宁丹东人，在读硕士研究生。E-mail：wangaibo007@163.com

引用本文:

王艾博1，罗佳文1，边杰1，刘军2，陈宏海1，翟方兵1，刘亚洁1，于传文1，张喜友1. 普美显对肝脏动脉期一过性强化灶与小肝癌检出的研究及与钆喷葡胺的比较研究[J]. 中国临床医学影像杂志, 2016, 27(12): 881-887.
WANG Ai-bo1, LUO Jia-wen1, BIAN Jie1, LIU Jun2, CHEN Hong-hai1, ZHAI Fang-bing1, LIU Ya-jie1, YU Chuan-wen1, ZHANG Xi-you1. A study of primovist in distinguishing transient hepatic parenchymal enhancement from small hepatocellular carcinoma and a comparison with non-specific contrast agent. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(12): 881-887.

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http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2016/V27/I12/881

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