基于Gd-E0B-DTPA结合大偏转角技术的肝局灶性病变定性诊断研究
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摘要
目的探讨基于钆塞酸二钠(Gd-EOB-DTPA)结合大偏转角技术的肝局灶性病变定性诊断。方法选取肝局灶性病变患者62例,患者均进行Gd-EOB-DTPA增强MRI扫描,分别行5 min、10 min、20 min延迟扫描,采用常规的低偏转角(10°)及大偏转角(20°)法获得肝胆期图像,比较Gd-E0B-DTPA结合低偏转角及大偏转角对肝局灶性病变定性诊断的敏感度、特异度。结果经Kappa检验,在低偏转角、大偏转角检测肝局灶性病变的k值中,5 min分别为0.95、0.95,10 min分别为0.93、0.82,20 min分别为0.96、1.00;大偏转角成像的敏感度均明显高于低偏转角成像,差异均有统计意义(χ2分别=9.89、10.67、20.08、14.73、5.03、9.48,P均<0.05);病灶大小≤10 mm中大偏转角成像的敏感度均明显高于低偏转角成像,差异均有统计意义(χ2分别=4.22、4.89、8.42、8.42、12.52、12.52,P均<0.05),各时间点检测恶性病灶大偏转角成像的敏感度均明显高于低偏转角成像,差异均有统计意义(χ2分别=5.86、5.86、15.24、11.16、7.60、5.64,P均<0.05);肝癌中大偏转角成像的敏感度均明显高于低偏转角成像,差异均有统计意义(χ2分别=7.63、6.23、8.16、4.94、6.34、6.34,P均<0.05);在转移灶检测中两者无明显差异(χ2分别=0.29、0.29、3.41、3.41、0.21、0.21,P均>0.05)。结论 Gd-E0B-DTPA结合大偏转角技术可提高对肝局灶性病变定性诊断的敏感度,为临床制定治疗方案提供可靠资料。
Objective To investigate the qualitative diagnosis of focal liver lesions based on Gd-E0 B-DTPA combined with large deflection angle technique. Methods Totally 62 patients with focal liver lesions were selected. The patients underwent Gd-EOB-DTPA enhanced MRI scan at 5 min,10 min and 20 min delayed scanning respectively. The conventional low angle(10 degrees)and large deflection angle(20 degrees)were used to obtain hepatobiliary phase images. The sensitivity and specificity of qualitative diagnosis of focal liver lesions were compared between the Gd-E0 B-DTPA combined with the low deflection angle or the large deflection angle. Results At 5 minuts delayed scanning,the Kappa values of the low deflection angle and high deflection angle in detection of focal liver lesions were 0.95 and 0.95 respectively. At 10 minuts delayed scanning,the Kappa values were 0.93 and 0.82,at 20 minuts delayed scanning,the Kappa values were 0.96 and 1.00.The sensitivities of large deflection angle imaging were significantly higher than those of low deflection angle imaging at 5 min,10 min and 20 min delayed scanning(χ2=9.89,10.67,20.08,14.73,5.03,9.48,P<0.05). In patients with lesion size less than 10 mm,the sensitivity of large deflection angle imaging was significantly higher than that of low deflection angle imaging(χ2=4.22,4.89,8.42,8.42,12.52,12.52,P<0.05).The sensitivity of large deflection angle imaging for detecting malignant lesions was significantly higher than that of low deflection angle imaging(χ2=5.86,5.86,15.24,11.16,7.60,5.64,P<0.05)as well as for detecting liver cancer(χ2=7.63,6.23,8.16,4.94,6.34,6.34,P<0.05). There was no difference in detection of metastases between two deflection angle imagings(χ2=0.29,0.29,3.41,3.41,0.21,0.21,P>0.05). Conclusion Gd-E0 BDTPA combined with large deflection angle technique can improve the sensitivity of qualitative diagnosis of focal liver lesions and provide reliable data for clinical treatment.
Objective To investigate the qualitative diagnosis of focal liver lesions based on Gd-E0 B-DTPA combined with large deflection angle technique. Methods Totally 62 patients with focal liver lesions were selected. The patients underwent Gd-EOB-DTPA enhanced MRI scan at 5 min,10 min and 20 min delayed scanning respectively. The conventional low angle(10 degrees)and large deflection angle(20 degrees)were used to obtain hepatobiliary phase images. The sensitivity and specificity of qualitative diagnosis of focal liver lesions were compared between the Gd-E0 B-DTPA combined with the low deflection angle or the large deflection angle. Results At 5 minuts delayed scanning,the Kappa values of the low deflection angle and high deflection angle in detection of focal liver lesions were 0.95 and 0.95 respectively. At 10 minuts delayed scanning,the Kappa values were 0.93 and 0.82,at 20 minuts delayed scanning,the Kappa values were 0.96 and 1.00.The sensitivities of large deflection angle imaging were significantly higher than those of low deflection angle imaging at 5 min,10 min and 20 min delayed scanning(χ2=9.89,10.67,20.08,14.73,5.03,9.48,P<0.05). In patients with lesion size less than 10 mm,the sensitivity of large deflection angle imaging was significantly higher than that of low deflection angle imaging(χ2=4.22,4.89,8.42,8.42,12.52,12.52,P<0.05).The sensitivity of large deflection angle imaging for detecting malignant lesions was significantly higher than that of low deflection angle imaging(χ2=5.86,5.86,15.24,11.16,7.60,5.64,P<0.05)as well as for detecting liver cancer(χ2=7.63,6.23,8.16,4.94,6.34,6.34,P<0.05). There was no difference in detection of metastases between two deflection angle imagings(χ2=0.29,0.29,3.41,3.41,0.21,0.21,P>0.05). Conclusion Gd-E0 BDTPA combined with large deflection angle technique can improve the sensitivity of qualitative diagnosis of focal liver lesions and provide reliable data for clinical treatment.
引文
1张薇薇,刘曦娇,李峥艳,等.Gd-EOB-DTPA增强MRI在肝脏局灶性病变中的应用进展[J].放射学实践,2016,31(1):44-48.
2 蔡华崧,伍玲,周丽莎,等.Gd-EOB-DTPA增强扫描前后T2 WI对肝脏局灶性病变检出情况的比较[J].新医学,2015,46(10):661-667.
3 郭卫华,赵素红,杨玉海,等.静脉注射Gd-DTPA肝脏局灶性病变弥散加权成像的定量对照研究[J].中国现代普通外科进展,2015,18(6):441-444.
4 田园,刘鹏飞,孙鹏,等.钆塞酸二钠MR增强延迟期对肝脏局灶性病变的诊断价值[J].哈尔滨医科大学学报,2016,50(4):337-341.
5 李晓明,王玉婷,赵骏,等.Gd-EOB-DTPA增强MRI诊断肝脏非典型局灶结节增生的临床价值[J].放射学实践,2015,30(12):1212-1216.
6 丁丁,陆健,黎美玲,等.肝功能正常患者Gd-EOB-DTPA增强MRI肝胆期延迟时间的研究[J].磁共振成像,2015,6(10):757-761.
7 邢飞,陆健,张涛,等.Gd-EOB-DTPA对肝硬化交界性结节的诊断及预后[J].临床放射学杂志,2016,35(10):1521-1524.
8 周智鹏,邱维加,张辉阳,等.Gd-EOB-DTPA灌注扫描定量参数联合肝胆特异期图像对肝癌的诊断价值[J].临床放射学杂志,2016,35(3):380-384.
9 谢玉婷.MRI肝内不典型影像表现病灶的动态增强与肿瘤良恶性的相关性研究[J].全科医学临床与教育,2017,15(1):31-34.
10 刘永存,伍丽萍.STKⅡ在肝癌组织中的表达水平分析及临床意义[J].空军医学杂志,2016,32(5):319-322.
11 黄海东,曾蒙苏,丁玉芹,等.Gd-EOB-DTPA磁共振成像在慢性肝炎背景下小肝癌诊断中的应用[J].临床放射学杂志,2015,34(7):1085-1089.
12 Andrzej C,Joanna P,Grzegorz R,et al.Gd-EOB-DTPAEnhanced MR Imaging of the liver:the effect on T2 relaxation times and apparent diffusion coefficient(ADC)[J].PJR,2016,81(1):103-109.
13 高鑫,张磊.动态增强MRI半定量及时间-信号强度曲线对原发性肝细胞肝癌的诊断价值[J].解放军医药杂志,2016,28(8):56-60.
14 蔡华崧,王猛,翟凤仪,等.两种不同激励脉冲角度对肝脏Gd-EOB-DTPA增强MRI肝细胞期病灶检出的比较[J].中国医学影像技术,2016,32(1):129-133.
15 王升忠.MR及CT对腹膜后肿瘤诊断的临床价值分析[J].保健医学研究与实践,2015,12(6):43-45.
16 李俊,帅存勇,陈立宇.原发性肝癌骨转移患者临床特征及预后影响因素分析[J].临床误诊误治,2015,30(7):92-95.
17 Norén B,Dahlstr?m N,Forsgren MF,et al.Visual assessment of biliary excretion of Gd-EOB-DTPA in patients with suspected diffuse liver disease-A biopsy-verified prospective study[J].Eur J Radiol,2015,28(1):19-25.
18 郑磊,张学彦,孔令建.肝癌干细胞的细胞分子标志物和信号通路的研究进展[J].解放军医药杂志,2015,27(4):99-102.
19 Esterson YB,Flusberg M,Oh S,et al.Improved parenchymal liver enhancement with extended delay on GdEOB-DTPA-enhanced MRI in patients with parenchymal liver disease:associated clinical and imaging factors[J].Clin Radiol,2015,70(7):723.
20 Daire JL,Leporq B,Vilgrain V,et al.Liver perfusion modifies Gd-DTPA and Gd-BOPTA hepatocyte concentrations through transfer clearances across sinusoidal membranes[J].Eur J Drug Metab Ph,2016,23(1):1-11.
2 蔡华崧,伍玲,周丽莎,等.Gd-EOB-DTPA增强扫描前后T2 WI对肝脏局灶性病变检出情况的比较[J].新医学,2015,46(10):661-667.
3 郭卫华,赵素红,杨玉海,等.静脉注射Gd-DTPA肝脏局灶性病变弥散加权成像的定量对照研究[J].中国现代普通外科进展,2015,18(6):441-444.
4 田园,刘鹏飞,孙鹏,等.钆塞酸二钠MR增强延迟期对肝脏局灶性病变的诊断价值[J].哈尔滨医科大学学报,2016,50(4):337-341.
5 李晓明,王玉婷,赵骏,等.Gd-EOB-DTPA增强MRI诊断肝脏非典型局灶结节增生的临床价值[J].放射学实践,2015,30(12):1212-1216.
6 丁丁,陆健,黎美玲,等.肝功能正常患者Gd-EOB-DTPA增强MRI肝胆期延迟时间的研究[J].磁共振成像,2015,6(10):757-761.
7 邢飞,陆健,张涛,等.Gd-EOB-DTPA对肝硬化交界性结节的诊断及预后[J].临床放射学杂志,2016,35(10):1521-1524.
8 周智鹏,邱维加,张辉阳,等.Gd-EOB-DTPA灌注扫描定量参数联合肝胆特异期图像对肝癌的诊断价值[J].临床放射学杂志,2016,35(3):380-384.
9 谢玉婷.MRI肝内不典型影像表现病灶的动态增强与肿瘤良恶性的相关性研究[J].全科医学临床与教育,2017,15(1):31-34.
10 刘永存,伍丽萍.STKⅡ在肝癌组织中的表达水平分析及临床意义[J].空军医学杂志,2016,32(5):319-322.
11 黄海东,曾蒙苏,丁玉芹,等.Gd-EOB-DTPA磁共振成像在慢性肝炎背景下小肝癌诊断中的应用[J].临床放射学杂志,2015,34(7):1085-1089.
12 Andrzej C,Joanna P,Grzegorz R,et al.Gd-EOB-DTPAEnhanced MR Imaging of the liver:the effect on T2 relaxation times and apparent diffusion coefficient(ADC)[J].PJR,2016,81(1):103-109.
13 高鑫,张磊.动态增强MRI半定量及时间-信号强度曲线对原发性肝细胞肝癌的诊断价值[J].解放军医药杂志,2016,28(8):56-60.
14 蔡华崧,王猛,翟凤仪,等.两种不同激励脉冲角度对肝脏Gd-EOB-DTPA增强MRI肝细胞期病灶检出的比较[J].中国医学影像技术,2016,32(1):129-133.
15 王升忠.MR及CT对腹膜后肿瘤诊断的临床价值分析[J].保健医学研究与实践,2015,12(6):43-45.
16 李俊,帅存勇,陈立宇.原发性肝癌骨转移患者临床特征及预后影响因素分析[J].临床误诊误治,2015,30(7):92-95.
17 Norén B,Dahlstr?m N,Forsgren MF,et al.Visual assessment of biliary excretion of Gd-EOB-DTPA in patients with suspected diffuse liver disease-A biopsy-verified prospective study[J].Eur J Radiol,2015,28(1):19-25.
18 郑磊,张学彦,孔令建.肝癌干细胞的细胞分子标志物和信号通路的研究进展[J].解放军医药杂志,2015,27(4):99-102.
19 Esterson YB,Flusberg M,Oh S,et al.Improved parenchymal liver enhancement with extended delay on GdEOB-DTPA-enhanced MRI in patients with parenchymal liver disease:associated clinical and imaging factors[J].Clin Radiol,2015,70(7):723.
20 Daire JL,Leporq B,Vilgrain V,et al.Liver perfusion modifies Gd-DTPA and Gd-BOPTA hepatocyte concentrations through transfer clearances across sinusoidal membranes[J].Eur J Drug Metab Ph,2016,23(1):1-11.