Gd-EOB-DTPA增強(qiáng)MR與超聲造影對(duì)富血供微小肝癌診斷評(píng)價(jià)
發(fā)布時(shí)間：2018-09-06 09:41
【摘要】：目的： 分析微小肝癌(直徑2cm)在超聲造影及Gd-EOB-DTPA增強(qiáng)MR中的影像表現(xiàn),并對(duì)兩者在微小肝癌(直徑2cm在)上的診斷準(zhǔn)確性進(jìn)行比較研究。 材料與方法： 選取本院2011年1月-2013年5月經(jīng)病理證實(shí)為肝細(xì)胞癌的病人48例(男性為31例,女性為17例,平均年齡為53.0±10.8歲)共計(jì)57個(gè)病灶。納入標(biāo)準(zhǔn)為：①所有病人經(jīng)過(guò)超聲造影(Contrast-enhanced ultrasound,CEUS)、 Gd-EOB-DTPA(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid)增強(qiáng)MRI及經(jīng)腸系膜上動(dòng)脈門靜脈造影CT (CT during arterial portography,CTAP)、肝動(dòng)脈內(nèi)插管的肝臟動(dòng)脈造影CT(CT during hepatic arteriography,CTHA)檢查。②病灶的最大徑2cm。③所有病灶必須在影像學(xué)檢查30天內(nèi)取得病理,包括外科術(shù)后或穿刺活檢。④肝癌病理診斷結(jié)果符合世界衛(wèi)生組織的分級(jí)標(biāo)準(zhǔn)。⑤患者對(duì)影像檢查及穿刺活檢知情同意,且經(jīng)醫(yī)院倫理委員會(huì)批準(zhǔn)。按照按病灶大小分為兩組即直徑1cm組(共計(jì)23個(gè)),及1cm直徑2cm(共計(jì)34個(gè)),分別統(tǒng)計(jì)兩組的病灶檢出率情況,并用ROC(Receiver operating characteristics curve,ROC)曲線對(duì)其診斷準(zhǔn)確性進(jìn)行評(píng)價(jià)。 結(jié)果： 1、影像表現(xiàn)：在57個(gè)病灶中,經(jīng)病理證實(shí)為微小肝癌(Minuteness hepatocellular carcinoma, MHCC)的為50個(gè),其它為2個(gè)RN,5個(gè)DN。CEUS:表現(xiàn)為典型“快進(jìn)快出”的39個(gè),表現(xiàn)為“快進(jìn)同出”的8個(gè),與周圍肝實(shí)質(zhì)同步增強(qiáng)的3個(gè),動(dòng)脈期晚于周邊肝實(shí)質(zhì)增強(qiáng)而余期等增強(qiáng)的4個(gè),全程無(wú)灌注的3個(gè)；Gd-EOB-DTPA增強(qiáng)MRI：表現(xiàn)為典型的T1WI低信號(hào)、T2WI高信號(hào)及肝膽期低信號(hào)的45個(gè),表現(xiàn)為T1WI高信號(hào)、T2WI低信號(hào)、肝膽期等信號(hào)的2個(gè),表現(xiàn)為T1WI等信號(hào)、T2WI等信號(hào)、肝膽期等信號(hào)4個(gè),表現(xiàn)為T1WI、T2WI等信號(hào)、肝膽期高信號(hào)6個(gè)。 2、兩種方法的檢出情況：48例57個(gè)病灶中,CEUS共檢出MHCC41個(gè),檢出率為71.93%；Gd-EOB-DTPA-MRI共檢出MHCC50個(gè),檢出率為87.72%。差異有統(tǒng)計(jì)學(xué)意義(χ2=4.412,p=0.036)。(1)在d1cm組共23個(gè)病灶中,CEUS發(fā)現(xiàn)MHCC共12個(gè),肝臟其它病變11個(gè),檢出率為52.17%,Gd-EOB-DTPA-MRI發(fā)現(xiàn)MHCC共19個(gè),其它4個(gè),檢出率為82.61%；差異有統(tǒng)計(jì)學(xué)意義(χ2=4.847,p=0.028),即Gd-EOB-DTPA-MRICEUS。(2)在1d2cm組共34個(gè)病灶中,CEUS發(fā)現(xiàn)MHCC共29個(gè),肝臟其它病變5個(gè),檢出率為85.29%,Gd-EOB-DTPA-MRI發(fā)現(xiàn)MHCC共31個(gè),其它3個(gè),檢出率為91.18%,兩種檢查方法對(duì)MHCC的檢出率差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.567,p=0.452)。 3、兩種檢查方法的診斷準(zhǔn)確性情況：(1)d1cm組中共23個(gè)病灶中經(jīng)病理診斷為肝癌的20個(gè),診斷為其它的3個(gè)。CEUS診斷為MHCC的12個(gè),診斷為其它的11個(gè),Gd-EOB-DTPA-MRI診斷為MHCC的19個(gè),診斷為其它的為4個(gè)。CEUS診斷靈敏度為60%(12/20),特異度為100%(3/3),準(zhǔn)確度為52.17%(12/23),陽(yáng)性預(yù)測(cè)值為100%(12/12),陰性預(yù)測(cè)值為27.3%(3/11)；Gd-EOB-DTPA-MRI診斷靈敏度為85%(17/20),特異度為33.3%(1/3),準(zhǔn)確度為82.61%(19/23),陽(yáng)性預(yù)測(cè)值為89.47%(17/19),陰性預(yù)測(cè)值為25%(1/4)。(2)1d2cm組中共34個(gè)病灶中經(jīng)病理診斷為肝癌的為30個(gè),診斷為其它的為4個(gè)。CEUS診斷為MHCC的為30個(gè),診斷為其它的為4個(gè),Gd-EOB-DTPA-MRI診斷為MHCC的為31個(gè),診斷為其它的為3個(gè)。CEUS診斷靈敏度為90%(27/30),特異度25%(1/4),準(zhǔn)確度為88.2%(30/34),陽(yáng)性預(yù)測(cè)值為90%(27/30),陰性預(yù)測(cè)值25%(1/4)；Gd-EOB-DTPA-MRI診斷靈敏度為93.3%(28/30),特異度33.3%(1/3),準(zhǔn)確度為91.2%(31/34),陽(yáng)性預(yù)測(cè)值為90.3%(28/31),陰性預(yù)測(cè)值33.3%(1/3)。 4、兩種方法的ROC分析情況：(1)d1cm組,CEUS的曲線下面積為0.633,95%可信區(qū)間為(0.293-0.974)；Gd-EOB-DTPA-MRI的曲線面積為0.758,95%可信區(qū)間為(0.00-1.00)。經(jīng)Z檢驗(yàn),Z=0.376,p0.05。兩者差別有統(tǒng)計(jì)學(xué)意義,即Gd-EOB-DTPA-MRICEUS.(2)1≤d2cm組,CEUS的曲線下面積為0.825,95%可信區(qū)間為(0.00-1.00)；Gd-EOB-DTPA-MRI的曲線面積為0.842,95%可信區(qū)間為(0.00-1.00)。經(jīng)Z檢驗(yàn),Z=0.376,p0.05。兩者差別無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論： CEUS與Gd-EOB-DTPA增強(qiáng)MRI對(duì)微小肝癌的檢出都有很高價(jià)值其中(1)病灶檢出能力：d1cm組中,Gd-EOB-DTPA-MRI高于CEUS,檢出率分別為82.61%、52.17%；在1d2cm組中Gd-EOB-DTPA-MRI與CEUS無(wú)顯著性差異,檢出率分別為91.18%、85.29%。(2)診斷準(zhǔn)確性：d1cm組中,Gd-EOB-DTPA-MRI屬中等水平,高于CEUS(ROC曲線下面積分別為0.758、0.633),兩者差異有統(tǒng)計(jì)學(xué)意義；1d2cm組中,Gd-EOB-DTPA-MRI與CEUS都屬中等偏上水平,(ROC曲線下面積分別為0.842、0.825),兩者差異無(wú)統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective:
To analyze the imaging manifestations of small hepatocellular carcinoma (2cm in diameter) on contrast-enhanced ultrasound and Gd-EOB-DTPA enhanced MR, and to compare the diagnostic accuracy of the two methods in small hepatocellular carcinoma (2cm in diameter).
Materials and methods:
From January 2011 to May 2013, 48 patients (31 males, 17 females, average age 53.0 (+ 10.8 years) with pathologically confirmed hepatocellular carcinoma were enrolled in this study. The inclusion criteria were as follows: 1. All patients underwent contrast-enhanced ultrasound (CEUS), Gd-EOB-DTPA (Gadolinium ethoxybenzyl diethylenetriamine). Pentaacetic acid enhanced MRI, CT during arterial portography (CTAP), hepatic artery angiography (CTHA) with hepatic artery intubation were performed. 2. The maximum diameter of the lesion was 2 cm. 3. All lesions must be pathologically examined within 30 days of imaging, including surgery or surgery. Puncture biopsy. (4) The pathological diagnosis of hepatocellular carcinoma conformed to WHO classification criteria. _Patients with informed consent to imaging and biopsy, and approved by the hospital ethics committee. According to the size of the lesion, they were divided into two groups: 1 cm in diameter group (23), and 1 cm in diameter 2 cm (34), respectively. The detection rates of the two groups were statistically analyzed. The diagnostic accuracy was evaluated by ROC (Receiver operating characteristics curve, ROC) curve.
Result:
1. Imaging manifestations: Of 57 lesions, 50 were pathologically confirmed as minimal hepatocellular carcinoma (MHCC), the others were 2 RN, 5 DN. CEUS: 39 were typical "fast in and fast out", 8 were "fast in and out" and 3 were synchronously enhanced with the surrounding hepatic parenchyma. The arterial phase was later than that of the peripheral hepatic parenchyma. Gd-EOB-DTPA enhanced MRI showed typical low signal on T1WI, high signal on T2WI and low signal on hepatobiliary phase, two high signal on T1WI, two low signal on T2WI and two signal on hepatobiliary phase, four signal on T1WI, four signal on T2WI and four signal on hepatobiliary phase. There are 6 high signals in hepatobiliary stage.
2. The detection rate of MHCC was 71.93% in CEUS and 87.72% in Gd-EOB-DTPA-MRI. The difference was statistically significant (2 = 4.412, P = 0.036). (1) Of the 23 lesions in d1cm group, 12 were detected by CEUS, 11 were detected by other liver lesions, the detection rate was 52.17%, Gd-EOB-DTPA-MRI was 87.72%. PA-MRI found 19 MHCC, the other 4, the detection rate was 82.61%; the difference was statistically significant (2 = 4.847, P = 0.028), that is, Gd-EOB-DTPA-MRICEUS. (2) In the 34 lesions of Gd-EOB-DTPA-MRICEUS group, CEUS found 29 MHCC, 5 other liver lesions, the detection rate was 85.29%, Gd-EOB-DTPA-MRI found 31 MHCC, the detection rate was 91.18%. Methods there was no significant difference in the detection rate of MHCC (2=0.567, p=0.452).
3. The diagnostic accuracy of the two methods: (1) Twenty of 23 lesions in d1cm group were diagnosed as hepatocellular carcinoma by pathology and three others by CEUS. Twelve lesions were diagnosed as MHCC by CEUS, 11 others by CEUS, 19 lesions were diagnosed as MHCC by Gd-EOB-DTPA-MRI, and 4 lesions were diagnosed as MHCC by Gd-EOB-DTPA-MRI. The sensitivity and specificity of CEUS were 60% (12/20) and 100% (3/3) respectively. The accuracy was 52.17% (12/23), the positive predictive value was 100% (12/12), the negative predictive value was 27.3% (3/11), the sensitivity of Gd-EOB-DTPA-MRI was 85% (17/20), the specificity was 33.3% (1/3), the accuracy was 82.61% (19/23), the positive predictive value was 89.47% (17/19), and the negative predictive value was 25% (1/4). (2) 34 lesions in 1D 2cm group were diagnosed as hepatocellular carcinoma by pathology. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS were 90% (27/30), 25% (1/4), 88.2% (30/34), 90% (27/30) and 25% (1/4) respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PA-MRI were 93.3% (28/30), 33.3% (1/3), 91.2% (31/34), 90.3% (28/31) and 33.3% (1/3) respectively.
4. ROC analysis of the two methods: (1) in d1cm group, the area under the curve of CEUS was 0.633, 95% confidence interval was (0.293-0.974); in Gd-EOB-DTPA-MRI, the area under the curve of Gd-EOB-DTPA-MRI was 0.758, 95% confidence interval was (0.00-1.00). After Z test, Z = 0.376, p0.05. The difference between the two methods was statistically significant, that is, the area under the curve of Gd-EOB-DTPA-MREUS was (2) 1 < d2cm group, the area under the curve of CEUS was 0.758, 95% confidence interval was (0.00 The curve area of Gd-EOB-DTPA-MRI was 0.842 and the 95% confidence interval was (0.00-1.00). There was no significant difference between the two methods by Z test.
Conclusion:
CEUS and Gd-EOB-DTPA enhanced MRI are of great value in the detection of micro-hepatocellular carcinoma. Among them, (1) Focal detection ability: Gd-EOB-DTPA-MRI in d1cm group was higher than that in CEUS, the detection rate was 82.61%, 52.17%; Gd-EOB-DTPA-MRI and CEUS had no significant difference in 1d2cm group, the detection rate was 91.18%, 85.29%. (2) Diagnostic accuracy: Gd-EOB-DTP-MRI in d1cm group was higher than that in CEUS. A-MRI was moderate, higher than CEUS (ROC curve under the score of 0.758, 0.633), the difference was statistically significant; 1D 2cm group, Gd-EOB-DTPA-MRI and CEUS were moderately above the level (ROC curve under the score of 0.842, 0.825), the difference was not statistically significant.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.7;R445.1;R445.2
本文編號(hào)：2225950
[Abstract]:Objective:
To analyze the imaging manifestations of small hepatocellular carcinoma (2cm in diameter) on contrast-enhanced ultrasound and Gd-EOB-DTPA enhanced MR, and to compare the diagnostic accuracy of the two methods in small hepatocellular carcinoma (2cm in diameter).
Materials and methods:
From January 2011 to May 2013, 48 patients (31 males, 17 females, average age 53.0 (+ 10.8 years) with pathologically confirmed hepatocellular carcinoma were enrolled in this study. The inclusion criteria were as follows: 1. All patients underwent contrast-enhanced ultrasound (CEUS), Gd-EOB-DTPA (Gadolinium ethoxybenzyl diethylenetriamine). Pentaacetic acid enhanced MRI, CT during arterial portography (CTAP), hepatic artery angiography (CTHA) with hepatic artery intubation were performed. 2. The maximum diameter of the lesion was 2 cm. 3. All lesions must be pathologically examined within 30 days of imaging, including surgery or surgery. Puncture biopsy. (4) The pathological diagnosis of hepatocellular carcinoma conformed to WHO classification criteria. _Patients with informed consent to imaging and biopsy, and approved by the hospital ethics committee. According to the size of the lesion, they were divided into two groups: 1 cm in diameter group (23), and 1 cm in diameter 2 cm (34), respectively. The detection rates of the two groups were statistically analyzed. The diagnostic accuracy was evaluated by ROC (Receiver operating characteristics curve, ROC) curve.
Result:
1. Imaging manifestations: Of 57 lesions, 50 were pathologically confirmed as minimal hepatocellular carcinoma (MHCC), the others were 2 RN, 5 DN. CEUS: 39 were typical "fast in and fast out", 8 were "fast in and out" and 3 were synchronously enhanced with the surrounding hepatic parenchyma. The arterial phase was later than that of the peripheral hepatic parenchyma. Gd-EOB-DTPA enhanced MRI showed typical low signal on T1WI, high signal on T2WI and low signal on hepatobiliary phase, two high signal on T1WI, two low signal on T2WI and two signal on hepatobiliary phase, four signal on T1WI, four signal on T2WI and four signal on hepatobiliary phase. There are 6 high signals in hepatobiliary stage.
2. The detection rate of MHCC was 71.93% in CEUS and 87.72% in Gd-EOB-DTPA-MRI. The difference was statistically significant (2 = 4.412, P = 0.036). (1) Of the 23 lesions in d1cm group, 12 were detected by CEUS, 11 were detected by other liver lesions, the detection rate was 52.17%, Gd-EOB-DTPA-MRI was 87.72%. PA-MRI found 19 MHCC, the other 4, the detection rate was 82.61%; the difference was statistically significant (2 = 4.847, P = 0.028), that is, Gd-EOB-DTPA-MRICEUS. (2) In the 34 lesions of Gd-EOB-DTPA-MRICEUS group, CEUS found 29 MHCC, 5 other liver lesions, the detection rate was 85.29%, Gd-EOB-DTPA-MRI found 31 MHCC, the detection rate was 91.18%. Methods there was no significant difference in the detection rate of MHCC (2=0.567, p=0.452).
3. The diagnostic accuracy of the two methods: (1) Twenty of 23 lesions in d1cm group were diagnosed as hepatocellular carcinoma by pathology and three others by CEUS. Twelve lesions were diagnosed as MHCC by CEUS, 11 others by CEUS, 19 lesions were diagnosed as MHCC by Gd-EOB-DTPA-MRI, and 4 lesions were diagnosed as MHCC by Gd-EOB-DTPA-MRI. The sensitivity and specificity of CEUS were 60% (12/20) and 100% (3/3) respectively. The accuracy was 52.17% (12/23), the positive predictive value was 100% (12/12), the negative predictive value was 27.3% (3/11), the sensitivity of Gd-EOB-DTPA-MRI was 85% (17/20), the specificity was 33.3% (1/3), the accuracy was 82.61% (19/23), the positive predictive value was 89.47% (17/19), and the negative predictive value was 25% (1/4). (2) 34 lesions in 1D 2cm group were diagnosed as hepatocellular carcinoma by pathology. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS were 90% (27/30), 25% (1/4), 88.2% (30/34), 90% (27/30) and 25% (1/4) respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PA-MRI were 93.3% (28/30), 33.3% (1/3), 91.2% (31/34), 90.3% (28/31) and 33.3% (1/3) respectively.
4. ROC analysis of the two methods: (1) in d1cm group, the area under the curve of CEUS was 0.633, 95% confidence interval was (0.293-0.974); in Gd-EOB-DTPA-MRI, the area under the curve of Gd-EOB-DTPA-MRI was 0.758, 95% confidence interval was (0.00-1.00). After Z test, Z = 0.376, p0.05. The difference between the two methods was statistically significant, that is, the area under the curve of Gd-EOB-DTPA-MREUS was (2) 1 < d2cm group, the area under the curve of CEUS was 0.758, 95% confidence interval was (0.00 The curve area of Gd-EOB-DTPA-MRI was 0.842 and the 95% confidence interval was (0.00-1.00). There was no significant difference between the two methods by Z test.
Conclusion:
CEUS and Gd-EOB-DTPA enhanced MRI are of great value in the detection of micro-hepatocellular carcinoma. Among them, (1) Focal detection ability: Gd-EOB-DTPA-MRI in d1cm group was higher than that in CEUS, the detection rate was 82.61%, 52.17%; Gd-EOB-DTPA-MRI and CEUS had no significant difference in 1d2cm group, the detection rate was 91.18%, 85.29%. (2) Diagnostic accuracy: Gd-EOB-DTP-MRI in d1cm group was higher than that in CEUS. A-MRI was moderate, higher than CEUS (ROC curve under the score of 0.758, 0.633), the difference was statistically significant; 1D 2cm group, Gd-EOB-DTPA-MRI and CEUS were moderately above the level (ROC curve under the score of 0.842, 0.825), the difference was not statistically significant.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.7;R445.1;R445.2
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