为了描述早期肝细胞癌在钆塞酸-增强核磁、动态对比造影剂增强CT、CT经动脉门静脉造影、CT的肝动脉造影四种检查方法的影像学表现。并比较其在小于等于2厘米的小肝癌中的诊断效能。伦理委员会认为该回顾性研究不必经得批准。取自64例病人的108份小病灶标本分别为：12例不典型增生结节，66例进展期肝癌，30例早期肝癌。除其中的2例患者未接受外，其余的62例患者均接受了所有的影像学检查。每种形态病变的影像学特征均被确定确定。为评价这些诊断方式的诊断效能，由2名放射科医师用五级可信度法对存在的肝癌进行分级。 对每种诊断方式进行受试者工作特征曲线下的面积，灵敏度和特异性进行了比较。发育不良结节和早期肝细胞癌的影像学特征有明显的不同：含有脂肪组织的双回波T1加权核磁成像（见于16/30早期HCCs和0个发育不良结节）CT平扫低衰减（见于13/30早期HCCs和0个发育不良结节）CT经动脉门静脉造低衰减（见于11/30早期HCCs和0个发育不良结节） 钆塞酸增强核磁的肝细胞项低信号强度（见于29/30早期HCCs和0个发育不良结节）由于钆塞酸增强核磁的显著增高的敏感性(A(z), 0.98 and 0.99) ，其诊断效能明显优于对比增强CT（A（Z），0.87）及CT经动脉门静脉造和CT的肝动脉造影(A(z), 0.85 and 0.86)

(P < .001). 钆塞酸增强核磁共振扫描是评价小肝癌及早期肝癌最有效的影像学技术

吉林大学第一医院肝胆胰内科 孙海波 牛俊奇 摘译

本文首次发表于[Radiology. 2011, 261(3): 834-44]

Imaging Study of Early Hepatocellular Carcinoma: Usefulness of Gadoxetic Acid–enhanced MR Imaging

Aim: To describe imaging findings of early hepatocellular carcinoma (HCC) at gadoxetic acid-enhanced magnetic resonance(MR) imaging, dynamic contrast material-enhanced computed tomography (CT), CT during arterial portography (CTAP), and CT during hepatic arteriography (CTHA) and to compare the diagnostic performance of each modality for small (≤ 2 cm) HCC. Method:  The institute ethics committee deemed study approval unnecessary. One hundred eight resected small lesions in 64 patients were diagnosed as a dysplastic nodule (DN) (n = 12), progressed HCC (n = 66), or early HCC (n = 30). All but two patients underwent all imaging examinations. The imaging characteristics of the lesions with each modality were determined. To evaluate the diagnostic performance of the modalities, two radiologists graded the presence of HCC with use of a five-point confidence scale. The area under the receiver operating characteristic curve (A(z)), sensitivity, and specificity of each modality were compared. Results: The imaging features that are statistically significant for differentiating an early HCC from a DN include fat-containing lesions at dual-echo T1-weighted MR imaging (seen in 16 of the 30 early HCCs and none of the DNs), low attenuation at unenhanced CT (seen in 13 of the 30 early HCCs and none of the DNs), low attenuation at CTAP (seen in 11 of the 30 early HCCs and none of the DNs), and low signal intensity at hepatocyte phase gadoxetic acid-enhanced MR imaging (seen in 29 of the 30 early HCCs and none of the DNs). The diagnostic performance of gadoxetic acid-enhanced MR imaging (A(z), 0.98 and 0.99) was significantly greater than that of contrast-enhanced CT (A(z), 0.87) and CTHA-CTAP owing to its significantly higher sensitivity. Conclusion: Gadoxetic acid-enhanced MR imaging is the most useful imaging technique for evaluating small HCC, including early HCC.点击下载此文件