3.0 T MR-LAVA序列多期动态增强扫描对肝硬化结节病变定性诊断的临床价值研究
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摘要
目的比较使用3.0 T磁共振-肝脏容积快速采集(MR-LAVA)序列多期动态增强扫描定性诊断肝硬化结节病变的价值。方法 2015年1月～2017年8月我院诊治的乙型肝炎肝硬化患者,行3.0 T MR-LAVA序列多期动态增强扫描和CT增强检查。比较两种检查方法检出病灶情况及其表现特征。结果 MR-LAVA序列扫描检出病灶80例,而增强CT扫描检出病灶73例(91.3%);MR-LAVA序列检查定性诊断为局灶性结节性增生40例,血管瘤13例,原发性肝癌10例(均表现为富血供病变),转移瘤17例,而CT检查定性诊断为局灶性结节增生34例,血管瘤12例,肝细胞癌9例和转移瘤18例。结论 3.0 T MR-LAVA序列多期动态增强扫描能提高对肝硬化结节病变的定性诊断,值得临床进一步验证。
Objective To investigate the value of 3.0 T MR-liver acceleration volume acquisition(LAVA sequence multi-phase dynamic enhanced scanning in qualitative diagnosis of intrahepatic nodular lesions in patients with liver cirrhosis(LC). Methods Patients with LC were recruited in our hospital between January 2015 and August 2017. All patients underwent multi-phase dynamic contrast-enhanced CT scan and 3.0 T MR-LAVA sequences scan. Results MR-LAVA scan revealed 80 patients with intrahepatic lesions,while out of them the CT scan demonstrated in 73 cases(91.3%);the MR-LAVA provided diagnosis of focal nodular hyperplasia in 40,hepatic hemangioma in 13,primary liver cancer in 10,and metastatic tumors in 12 patients,while the CT scan diagnosed focal nodular hyperplasia in 34,hepatic hemangioma in 12,primary liver cancer in 9,and metastatic tumors in 18. Conclusion Multi-phase dynamic enhanced scan of 3.0 T MR-LAVA sequence scan might be an efficient approach in qualitatively diagnosing intrahepatic lesions,which could help clinicians to make decisions early.
Objective To investigate the value of 3.0 T MR-liver acceleration volume acquisition(LAVA sequence multi-phase dynamic enhanced scanning in qualitative diagnosis of intrahepatic nodular lesions in patients with liver cirrhosis(LC). Methods Patients with LC were recruited in our hospital between January 2015 and August 2017. All patients underwent multi-phase dynamic contrast-enhanced CT scan and 3.0 T MR-LAVA sequences scan. Results MR-LAVA scan revealed 80 patients with intrahepatic lesions,while out of them the CT scan demonstrated in 73 cases(91.3%);the MR-LAVA provided diagnosis of focal nodular hyperplasia in 40,hepatic hemangioma in 13,primary liver cancer in 10,and metastatic tumors in 12 patients,while the CT scan diagnosed focal nodular hyperplasia in 34,hepatic hemangioma in 12,primary liver cancer in 9,and metastatic tumors in 18. Conclusion Multi-phase dynamic enhanced scan of 3.0 T MR-LAVA sequence scan might be an efficient approach in qualitatively diagnosing intrahepatic lesions,which could help clinicians to make decisions early.
引文
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[26]Chen Q,Shang W,Zeng C,et al.Theranostic imaging of liver cancer using targeted optical/MRI dual-modal probes.Oncotarget,2017,8(20):32741-32751.
[27]Lee DH,Lee JM,Hur BY,et al.Colorectal cancer liver metastases:Diagnostic performance and prognostic value of PET/MR imaging.Radiology,2016,280(3):151975.
[2]Wang YC,Chou CT,Lin CP,et al.The value of Gd-EOB-DT-PA-enhanced MR imaging in characterizing cirrhotic nodules with atypical enhancement on Gd-DTPA-enhanced MR images.Plos One,2017,12(3):e0174594.
[3]Jo PC,Jang HJ,Burns PN,et al.Integration of contrast-enhanced US into a multimodality approach to imaging of nodules in a cirrhotic liver:How I do it.Radiology,2017,282(2):317-331.
[4]Chiu NC,Su CW,Liu CA,et al.Interval to vascularization development in cirrhotic precursor nodules in patients with hepatitis B and C virus co-infections.Plos One,2017,12(6):e0178841.
[5]Moayed AS,Hadi IM,Hossein IM.Predictive factors in the incidence of cirrhosis in chronic hepatitis B virus infections.Hepat Mon,2016,16(5):e34790.
[6]Qureshi NR,Shah A,Eaton RJ,et al.Dynamic contrast enhanced CT in nodule characterization:How we review and report.Cancer Imaging,2016,16(1):16.
[7]Huang B,Wu L,Lu XY,et al.Small intrahepatic cholangiocarcinoma and hepatocellular carcinoma in cirrhotic livers may share similar enhancement patterns at multiphase dynamic MRimaging.Radiology,2016,281(1):150-157.
[8]Zhang W,Chen HJ,Wang ZJ,et al.Dynamic contrast enhanced MR imaging for evaluation of angiogenesis of hepatocellular nodules in liver cirrhosis in N-nitrosodiethylamine induced rat model.Eur Radiol,2017,27(5):1-9.
[9]汪登斌.肝脏疾病影像学诊断技术新进展.实用肝脏病杂志,2018,21(4):489-492.
[10]孙维高,卢定友.DWI序列ADC值联合LAVA在肝脏恶性肿瘤诊断中的应用价值探讨.实用肝脏病杂志,2017,20(4):447-450.
[11]Saitta C,Raffa G,Alibrandi A,et al.PIVKA-II is a useful tool for diagnostic characterization of ultrasound-detected liver nodules in cirrhotic patients.Medicine,2017,96(26):e7266.
[12]Kim H,Park CM,Park SJ,et al.Temporal changes of texture features extracted from pulmonary nodules on dynamic contrast-enhanced chest computed tomography:How influential is the scan delay Invest Radiol,2016,51(9):569-574.
[13]Ippolito D,Querques G,Okolicsanyi S,et al.Diagnostic value of dynamic contrast-enhanced CT with perfusion imaging in the quantitative assessment of tumor response to sorafenib in patients with advanced hepatocellular carcinoma:A feasibility study.Eur J Radiol,2017,90(1):34-41.
[14]Shah A,Tang A,Santillan C,et al.Cirrhotic liver:What's that nodule The LI-RADS approach.J Magn Reson Imaging,2016,43(2):281-294.
[15]张宏春,耿喆.增强CT扫描与超声造影对肝脏占位性病变的临床诊断价值比较.实用肝脏病杂志,2016,19(6):696-699.
[16]Rizzo F,Rinaldi A,Marchese G,et al.Specific patterns of PI-WI-interacting small noncoding RNA expression in dysplastic liver nodules and hepatocellular carcinoma.Oncotarget,2016,7(34):54650-54661.
[17]Peng C,KascákováS,Chiappini F,et al.Discrimination of cirrhotic nodules,dysplastic lesions and hepatocellular carcinoma by their vibrational signature.J Transl Med,2016,14(1):9.
[18]Beal EW,Kearney JF,Chakedis JM,et al.Interval magnetic resonance imaging:an alternative to guidelines for indeterminate nodules discovered in the cirrhotic liver.J Gastrointest Surg,2017,21(9):1463-1470.
[19]J oung JG,Ha SY,Bae JS,et al.Nonlinear tumor evolution from dysplastic nodules to hepatocellular carcinoma.Oncotarget,2017,8(2):2076-2082.
[20]Martino MD,Anzidei M,Zaccagna F,et al.Qualitative analysis of small(≤2 cm)regenerative nodules,dysplastic nodules and well-differentiated HCCs with gadoxetic acid MRI.BMC Med Imaging,2016,16(1):62.
[21]张琦,李宏军,李云芳,等.HBV相关肝硬化结节癌变的MR增强特征与GPC-3、CD34表达的对应性研究.首都医科大学学报,2016,37(5):672-679.
[22]Choi SH,Lee SS,Kim SY,et al.Intrahepatic cholangiocarcinoma in patients with cirrhosis:Differentiation from hepatocellular carcinoma by using gadoxetic acid-enhanced MR imaging and dynamic CT.Radiology,2016,282(3):160639.
[23]Abd ABM,Abd E,El Sammak AA.Diagnostic efficacy of the liver imaging-reporting and data system(LI-RADS)with CTimaging in categorising small nodules(10-20 mm)detected in the cirrhotic liver at screening ultrasound.Clin Radiol,2017,72(10):901.e1-901.e11.
[24]Darnell A,Forner A,Rimola J,et al.Liver imaging reporting and aata system with MR imaging:Evaluation in nodules 20mm or smaller detected in cirrhosis at screening US.Radiology,2015,275(3):698-707.
[25]Tang A,Valasek MA,Sirlin CB.Update on the liver imaging reporting and data system:What the pathologist needs to know.Adv Anat Pathol,2015,22(5):314-322.
[26]Chen Q,Shang W,Zeng C,et al.Theranostic imaging of liver cancer using targeted optical/MRI dual-modal probes.Oncotarget,2017,8(20):32741-32751.
[27]Lee DH,Lee JM,Hur BY,et al.Colorectal cancer liver metastases:Diagnostic performance and prognostic value of PET/MR imaging.Radiology,2016,280(3):151975.