Gd-EOB-DTPA增强MR与超声造影对富血供微小肝癌诊断评价
发布时间：2018-09-06 09:41
【摘要】：目的： 分析微小肝癌(直径2cm)在超声造影及Gd-EOB-DTPA增强MR中的影像表现,并对两者在微小肝癌(直径2cm在)上的诊断准确性进行比较研究。 材料与方法： 选取本院2011年1月-2013年5月经病理证实为肝细胞癌的病人48例(男性为31例,女性为17例,平均年龄为53.0±10.8岁)共计57个病灶。纳入标准为：①所有病人经过超声造影(Contrast-enhanced ultrasound,CEUS)、 Gd-EOB-DTPA(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid)增强MRI及经肠系膜上动脉门静脉造影CT (CT during arterial portography,CTAP)、肝动脉内插管的肝脏动脉造影CT(CT during hepatic arteriography,CTHA)检查。②病灶的最大径2cm。③所有病灶必须在影像学检查30天内取得病理,包括外科术后或穿刺活检。④肝癌病理诊断结果符合世界卫生组织的分级标准。⑤患者对影像检查及穿刺活检知情同意,且经医院伦理委员会批准。按照按病灶大小分为两组即直径1cm组(共计23个),及1cm直径2cm(共计34个),分别统计两组的病灶检出率情况,并用ROC(Receiver operating characteristics curve,ROC)曲线对其诊断准确性进行评价。 结果： 1、影像表现：在57个病灶中,经病理证实为微小肝癌(Minuteness hepatocellular carcinoma, MHCC)的为50个,其它为2个RN,5个DN。CEUS:表现为典型“快进快出”的39个,表现为“快进同出”的8个,与周围肝实质同步增强的3个,动脉期晚于周边肝实质增强而余期等增强的4个,全程无灌注的3个；Gd-EOB-DTPA增强MRI：表现为典型的T1WI低信号、T2WI高信号及肝胆期低信号的45个,表现为T1WI高信号、T2WI低信号、肝胆期等信号的2个,表现为T1WI等信号、T2WI等信号、肝胆期等信号4个,表现为T1WI、T2WI等信号、肝胆期高信号6个。 2、两种方法的检出情况：48例57个病灶中,CEUS共检出MHCC41个,检出率为71.93%；Gd-EOB-DTPA-MRI共检出MHCC50个,检出率为87.72%。差异有统计学意义(χ2=4.412,p=0.036)。(1)在d1cm组共23个病灶中,CEUS发现MHCC共12个,肝脏其它病变11个,检出率为52.17%,Gd-EOB-DTPA-MRI发现MHCC共19个,其它4个,检出率为82.61%；差异有统计学意义(χ2=4.847,p=0.028),即Gd-EOB-DTPA-MRICEUS。(2)在1d2cm组共34个病灶中,CEUS发现MHCC共29个,肝脏其它病变5个,检出率为85.29%,Gd-EOB-DTPA-MRI发现MHCC共31个,其它3个,检出率为91.18%,两种检查方法对MHCC的检出率差异无统计学意义(χ2=0.567,p=0.452)。 3、两种检查方法的诊断准确性情况：(1)d1cm组中共23个病灶中经病理诊断为肝癌的20个,诊断为其它的3个。CEUS诊断为MHCC的12个,诊断为其它的11个,Gd-EOB-DTPA-MRI诊断为MHCC的19个,诊断为其它的为4个。CEUS诊断灵敏度为60%(12/20),特异度为100%(3/3),准确度为52.17%(12/23),阳性预测值为100%(12/12),阴性预测值为27.3%(3/11)；Gd-EOB-DTPA-MRI诊断灵敏度为85%(17/20),特异度为33.3%(1/3),准确度为82.61%(19/23),阳性预测值为89.47%(17/19),阴性预测值为25%(1/4)。(2)1d2cm组中共34个病灶中经病理诊断为肝癌的为30个,诊断为其它的为4个。CEUS诊断为MHCC的为30个,诊断为其它的为4个,Gd-EOB-DTPA-MRI诊断为MHCC的为31个,诊断为其它的为3个。CEUS诊断灵敏度为90%(27/30),特异度25%(1/4),准确度为88.2%(30/34),阳性预测值为90%(27/30),阴性预测值25%(1/4)；Gd-EOB-DTPA-MRI诊断灵敏度为93.3%(28/30),特异度33.3%(1/3),准确度为91.2%(31/34),阳性预测值为90.3%(28/31),阴性预测值33.3%(1/3)。 4、两种方法的ROC分析情况：(1)d1cm组,CEUS的曲线下面积为0.633,95%可信区间为(0.293-0.974)；Gd-EOB-DTPA-MRI的曲线面积为0.758,95%可信区间为(0.00-1.00)。经Z检验,Z=0.376,p0.05。两者差别有统计学意义,即Gd-EOB-DTPA-MRICEUS.(2)1≤d2cm组,CEUS的曲线下面积为0.825,95%可信区间为(0.00-1.00)；Gd-EOB-DTPA-MRI的曲线面积为0.842,95%可信区间为(0.00-1.00)。经Z检验,Z=0.376,p0.05。两者差别无统计学意义。 结论： CEUS与Gd-EOB-DTPA增强MRI对微小肝癌的检出都有很高价值其中(1)病灶检出能力：d1cm组中,Gd-EOB-DTPA-MRI高于CEUS,检出率分别为82.61%、52.17%；在1d2cm组中Gd-EOB-DTPA-MRI与CEUS无显著性差异,检出率分别为91.18%、85.29%。(2)诊断准确性：d1cm组中,Gd-EOB-DTPA-MRI属中等水平,高于CEUS(ROC曲线下面积分别为0.758、0.633),两者差异有统计学意义；1d2cm组中,Gd-EOB-DTPA-MRI与CEUS都属中等偏上水平,(ROC曲线下面积分别为0.842、0.825),两者差异无统计学意义。
[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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.7;R445.1;R445.2
本文编号：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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.7;R445.1;R445.2
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