【摘要】 目的探讨结合肝细胞期的钆塞酸二钠(Gd-EOB-DTPA)三期增强MRI对慢性肝炎背景下小肝细胞癌(HCC)结节(≤2cm)的诊断价值。方法对40例慢性肝炎合并肝占位性病变的患者进行Gd-EOB-DTPA增强MRI检查,根据Gd-EOB-DTPA不同特性用两种方法对MRI图像进行诊断分析:方法 A,对平扫、三期增强图像进行分析;方法 B,对平扫、三期增强和肝细胞期图像进行分析,然后与病理结果对照。采用Fisher确切概率法比较两种诊断方法的敏感度、特异度。结果 40例患者共发现53枚肝脏结节,病理结果显示39枚为HCC结节,27枚HCC结节增强MRI表现为富血供典型结节,12枚表现为不典型结节。不典型HCC结节病灶较小,平均直径为(0.8±0.3)cm,Edmondson-Steiner病理分级为Ⅰ~Ⅱ级;典型HCC结节平均直径为(1.4±0.4)cm,病理分级为Ⅱ~Ⅲ级。方法 A、B各检出HCC结节27、36枚,敏感度分别为69.2%、92.3%,两者差别有统计学意义(P<0.01);两者特异度均为85.7%。结论 Gd-EOB-DTPA增强MRI能够提高对慢性肝炎背景下HCC结节(≤2 cm),特别是不典型HCC结节的正确诊断率。更多还原

【Abstract】 Objective To evaluate the contribution of Gd-EOB-DTPA-enhanced MRI combined with the hepatobiliary phase in the diagnosis of small hepatocellular carcinoma(HCC) nodules(≤ 2 cm) in patients with chronic hepatitis.Methods 40 patients with nodular lesions of liver,which were pathologically confirmed,underwent Gd-EOB-DTPA-enhanced MRI.The images were analyzed by two methods:method A included the combined reading of unhanced and dynamic phase images; method B considered unhanced,dynamic phase and hepatobiliary phase images.Sensitivity and specificity of the two diagnostic methods were compared using Fisher exact test.Results 53 liver nodules were found in 40 patients,pathological results showed 39 HCC nodules,9 DN,3 RN.27 typical HCC nodules showed wash in and wash out,12 HCC nodules were found as atypical nodules,two cholangiocarcinoma nodules misdiagnosed as HCC,2 DN showed low signal in hepatobiliary phase.Atypical nodules showed more frequently smaller size(0.8 ± 0.3 cm),and nuclear gradeⅠ-Ⅱ,while the mean size of typical HCC nodules was 1.4 ± 0.4 cm,nuclear grade showedⅡ-Ⅲ.27,36 HCC nodules were characterized by methods A,B,respectively,and the sensitivity was 69.2% versus 92.3%(P < 0.01).The specificity of both group were 85.7%.Conclusion the new diagnostic criteria of Gd-EOB-DTPA-enhanced MRI combined with the hepatobiliary phase can improve the diagnostic capabilities against small HCC nodules(≤ 2 cm),especially atypical nodules in patients with chronic hepatitis.更多还原