增强MRI扫描在乙型肝炎肝硬化背景下对原发性肝癌的诊断价值分析*

doi:10.3969/j.issn.1672-5069.2022.04.025

摘要/Abstract

摘要： 目的研究采用钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)对乙型肝炎肝硬化背景下原发性肝癌(PLC)的诊断价值。方法 2018年12月～2020年12月我院收治的乙型肝炎肝硬化背景下肝脏局灶性病变患者147例,均行Gd-EOB-DTPA肝脏增强MRI扫描,观察病灶强化特点和各序列信号强度,包括T1加权像(T₁WI)、T2加权像(T₂WI)及动脉期、门脉期、肝胆特异期和磁共振弥散加权成像(DWI)病灶的信号强度。采用受试者工作特征(ROC)曲线下面积(AUC)分析上述信号特征对PLC的诊断效能。结果在147例患者中,发现PLC者102例,病灶大小为0.9～2.9 cm,平均为(1.8±0.6)cm,肝脏异型性增生结节45例,病灶大小为0.8～2.5 cm,平均为(1.4±0.2)cm;增强MRI扫描显示,84例表现为动脉期病灶呈低或等强化,门静脉期或延迟期呈低强化,63例表现为动脉期明显强化,门静脉期或延迟期未廓清;PLC组病灶T₁WI低信号、T₂WI高信号、DWI高信号、动脉期高强化和肝胆期低信号表现占比分别为50.0%、79.4%、82.4%、52.9%和94.1%,显著高于非PLC组(20.0%、20.0%、26.7%、20.0%和20.0%,P＜0.05);ROC分析结果显示病灶T₁WI低信号(AUC=0.670,敏感度=0.451)、T₂WI高信号(AUC=0.817,敏感度=0.745)、DWI高信号(AUC=0.754,敏感度=0.863)、动脉期高强化(AUC=0.693,敏感度=0.520)和肝胆期低信号(AUC=0.891,敏感度=0.892)对PLC具有一定的诊断效能(P＜0.05)。结论增强MRI扫描在乙型肝炎肝硬化背景下早期发现PLC具有重要的诊断价值,临床应不断总结其特点变化,提高早期诊断率。

关键词: 原发性肝癌, 肝硬化, 磁共振成像, 钆塞酸二钠, 诊断

Abstract: Objective The aim of this study was to investigate the diagnostic efficacy of GD-EOB-DTPA enhanced magnetic resonance imaging (MRI) in differentiation of primary liver cancer (PLC) fromnodular regenerative hyperplasia of liver (NRH) in patients with hepatitis B cirrhosis. Methods 147 patients with hepatic focal lesions (HFL) in the background of hepatitis B cirrhosis were encountered in our hospital between December 2018 and December 2020, and all patients underwent GD-Eob-DTPA enhanced MRI scan. The foci enhancement characteristics and signal intensity in each sequence were observed, including T1-weighted image (T1WI), T2-weighted image (T2WI), and signal intensity of arterial phase, portal vein phase, hepatobiliary specific phase, and magnetic resonance diffusion weighted imaging (DWI). The area under receiver operating characteristic (ROC) curve (AUC) was applied to analyze the diagnostic efficacy of signal feature. Results Out of our 147 patients with HFL, the contrast-enhanced MRI scan made diagnosis of PLC in 102 cases, with the lesion size of 0.9-2.9 cm (average of 1.8±0.6 cm), and NRH in 45 cases, with lesion size of 0.8-2.5 cm (average of 1.4±0.2 cm); the enhanced MRI scan showed that low or equal enhancement in arterial phase, low enhancement in portal vein phase or in delayed phase in 84 cases, and significant enhancement in arterial stage, without clearance in portal or delayed stage in 63 cases; the proportions of low signal in T₁WI, high signal in T₂WI, high signal in DWI, increased enhancement in arterial phase, and low signal in hepatobiliary phase in patients with PLC were 50.0%, 79.4%, 82.4%, 52.9%, and 94.1%, significantly higher than 20.0%, 20.0%, 26.7%, 20.0% and 20.0% (P<0.05) in patients with NRH; the ROC analysis showed that the low signal in T₁WI (AUC=0.670, sensitivity=0.451), high signal in T₂WI (AUC=0.817, sensitivity=0.745), high signal in DWI (AUC=0.754, sensitivity=0.863), high enhancement in arterial phase (AUC=0.693, sensitivity=0.520) and low signal in hepatobiliary phase (AUC=0.891, sensitivity=0.892) had certain diagnostic efficacy for PLC (P<0.05). Conclusion The enhanced MRI scan plays an important role in the diagnosis of PLC under the background of hepatitis B-induced liver cirrhosis.

Key words: Hepatoma, Nodular regenerative hyperplasia, Liver cirrhosis, Magnetic resonance imaging, Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid, Diagnosis

王宝锋, 马彦高, 李义, 曾宪强, 周进学. 增强MRI扫描在乙型肝炎肝硬化背景下对原发性肝癌的诊断价值分析^*[J]. 实用肝脏病杂志, 2022, 25(4): 554-557.

Wang Baofeng, Ma Yangao, Li Yi, et al. Diagnostic efficacy of GD-EOB-DTPA enhanced MRI in differentiation of primary liver cancer from nodular regenerative hyperplasia of liver in patients with hepatitis B cirrhosis[J]. Journal of Practical Hepatology, 2022, 25(4): 554-557.

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增强MRI扫描在乙型肝炎肝硬化背景下对原发性肝癌的诊断价值分析^*

Diagnostic efficacy of GD-EOB-DTPA enhanced MRI in differentiation of primary liver cancer from nodular regenerative hyperplasia of liver in patients with hepatitis B cirrhosis

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