[1]刘海峰,许永生,刘钊,等.钆塞酸二钠增强磁共振和弥散加权成像诊断肝细胞癌TACE术后存活或复发病灶的价值[J].中国医学物理学杂志,2020,37(5):561-567.[doi:10.3969/j.issn.1005-202X.2020.05.006]
　LIU Haifeng,XU Yongsheng,LIU Zhao,et al.Diagnostic value of Gd-EOB-DTPA enhanced MRI and DWI in residual or recurrent lesionsafter TACE for hepatocellular carcinoma[J].Chinese Journal of Medical Physics,2020,37(5):561-567.[doi:10.3969/j.issn.1005-202X.2020.05.006]
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钆塞酸二钠增强磁共振和弥散加权成像诊断肝细胞癌TACE术后 存活或复发病灶的价值()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
37
期数:
2020年第5期
页码:
561-567
栏目:
医学影像物理
出版日期:
2020-05-25

文章信息/Info

Title:
Diagnostic value of Gd-EOB-DTPA enhanced MRI and DWI in residual or recurrent lesions after TACE for hepatocellular carcinoma
文章编号:
1005-202X（2020）05-0561-07
作者:
刘海峰; 许永生; 刘钊; 卢星如; 雷军强
兰州大学第一医院放射科，甘肃兰州730000
Author(s):
LIU Haifeng;  XU Yongsheng;  LIU Zhao;  LU Xingru;  LEI Junqiang
Department of Radiology, the First Hospital of Lanzhou University, Lanzhou 730000, China
关键词:
钆塞酸二钠; 弥散加权成像; 肝细胞癌; 经导管肝动脉化疗栓塞
Keywords:
Gd-EOB-DTPA diffusion weighted imaging hepatocellular carcinoma transcatheter arterial chemoembolization
分类号:
R735.7；R816
DOI:
10.3969/j.issn.1005-202X.2020.05.006
文献标志码:
A
摘要:
目的：探究钆塞酸二钠（Gd-EOB-DTPA）增强磁共振（MRI）和弥散加权成像（DWI）诊断肝细胞癌（HCC）经导管肝 动脉化疗栓塞（TACE）术后存活或复发病灶的价值。方法：前瞻性连续纳入初次接受TACE治疗的96 例患者的129 个 HCC病灶。以CT 和/或MRI 随访，手术病理为诊断金标准，探究Gd-EOB-DTPA增强MRI 和DWI 对TACE术后1~2 月 HCC病灶存活或复发的诊断准确性，并采用ROC曲线分析ADC值对存活或复发病灶的鉴别诊断价值。运用卡方检验分 析T1WI信号、T2WI信号、形态、包膜、DWI信号、动脉期增强表现及肝特异期信号判断TACE术后存活或复发的价值。结 果：（1）金标准证实TACE术后存活病灶29个，肝内复发病灶18个，完全坏死病灶82个；（2）TACE术后HCC存活或复发病 灶多呈现出T1WI 低信号、T2WI 高信号、DWI 高信号的表现，89.36%（42/47）病灶动脉期强化，91.49%（43/47）肝细胞期未 见造影剂摄取呈低信号；（3）Gd-EOB-DTPA增强MRI 和DWI 诊断TACE术后存活或复发病灶的敏感度、特异度分别为 93.62%和91.49%、96.34%和95.12%，两者联合诊断的敏感度和特异度为95.74%、100.00%；（4）病灶无包膜、DWI高信号、 动脉期增强是判断TACE术后存活或复发的独立重要因素（P<0.05）。结论：Gd-EOB-DTPA增强MRI和DWI对TACE术 后HCC存活或复发病灶具有较高的诊断价值，可应用于TACE术后临床随访。
Abstract:
Objective To investigate the value of Gd-EOB-DTPA enhanced magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) in the diagnosis of residual or recurrent lesions after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods Aprospective and consecutive study was performed on 96 patients with 129 HCC lesions who had undergone TACE. The follow-up results by CT and/or MRI and surgery pathology were taken as the diagnostic gold standard, and the diagnostic accuracy of Gd-EOB-DTPA enhanced MRI and DWI in detecting residual or recurrent lesions at 1-2 months after TACE for HCC was investigated. Meanwhile, receiver operating characteristics (ROC) curve was used to evaluate the value of apparent diffusion coefficient (ADC) in the differential diagnosis of residual or recurrent lesions. Moreover, the diagnostic value of imaging signs in residual or recurrent lesions after TACE was explored by Chi-square test. The discussed imaging signs included T1WI signal, T2WI signal, morphology, capsule, DWI signal, arterial-phase enhancement performance and liver-specific phase signal. Results The evaluation by gold standard confirmed that there were 29 residual lesions, 18 hepatic recurrent lesions and 82 necrotic lesions after TACE. The residual or recurrent lesions after TACE were characterized with hypointense on T1WI, hyperintense on T2WI and hyperintense on DWI. The residual or recurrent lesions with enhancement in arterial phase accounted for 89.36% (42/47) and those without hypointense of contrast agent uptake in hepatocellular phase accounted for 91.49% (43/47). The sensitivity and specificity of Gd-EOB-DTPA enhanced MRI in the diagnosis of residual or recurrent lesions after TACE were 93.62% and 96.34%, respectively, and those of DWI were 91.49% and 95.12%, respectively. The sensitivity and specificity of the combination reached 95.74% and 100.00%. No capsule, hyperintense on DWI and the enhancement of arterial-phase signal were important independent factors in diagnosing residual or recurrent lesions after TACE (P<0.05). Conclusion Gd-EOB-DTPAenhanced MRI combined with DWI has excellent diagnostic value in residual or recurrent lesions after TACE in HCC and can be used in the clinical follow-up after TACE.

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备注/Memo

备注/Memo:
【收稿日期】2020-01-06 【基金项目】国家自然科学基金（81960323）；兰州大学中央高校基本科研业务（lzujbky-2019-cd04）；甘肃省自然科学基金（1506RJZA265） 【作者简介】刘海峰，硕士，住院医师，研究方向：腹部影像学，E-mail: liuhfyx@163.com 【通信作者】雷军强，主任医师，教授，研究方向：腹部影像学、循证医学，E-mail: leijq2011@126.com
更新日期/Last Update: 2020-06-03