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目的:比较肝细胞特异性对比剂普美显与非特异性细胞外间隙对比剂钆喷葡胺(Gd-DTPA)对肝脏动脉期一过性强化灶(Transient hepatic parenchymal enhancement,THPE)与小肝癌(Small hepatocelluar carcinoma,SHCC)鉴别诊断的能力。同时分析THPE及SHCC的形态、信号特征及应用两种对比剂的强化特征。方法:由两名影像医师共同对46名肝硬化患者的58个肝内局限性动脉期强化灶进行分析。主要分析在分别应用非特异性细胞外间隙对比剂Gd-DTPA及肝细胞特异性对比剂普美显(Gd-EOB-DTPA)的情况下各强化灶的信号、形态特征,以及增强扫描时强化方式的差别,进而综合判断病灶的性质。以手术或穿刺病理结果、介入血管造影或6月以上随诊观察等指标作为金标准,回顾性分析比较两种对比剂对于肝脏THPE和SHCC的诊断及鉴别能力。统计学方法采用卡方检验,比较THPE与SHCC在形态、位置、信号及强化方式上的差异;比较THPE的强化方式在应用两种对比剂时是否存在差异;比较SHCC的强化方式在应用两种对比剂时是否存在差异。分别比较研究总体58个肝内局限性动脉期强化灶组、36个结节状肝内局限性动脉期强化灶组和23个最大径<1 cm的肝内局限性动脉期强化灶组,应用两种对比剂诊断的灵敏度、特异度,计算ROC曲线下面积,从而比较两种对比剂的诊断效能。P<0.05为差异具有统计学意义。39例THPE中,33例经随诊6月得到确认,6例经介入血管造影得到确认。19例SHCC,10例由手术后病理得到证实,1例经皮肝脏穿刺活检并结合血管造影得到确认,另有8例由血管造影结合AFP指标得到证实。结果:在不同分组下,普美显的灵敏度、特异度及ROC曲线下面积均高于钆喷葡胺。THPE与SHCC在形态、位置、信号、强化方式上存在差异(P<0.05)。THPE的强化方式在应用两种对比剂时无统计学差异(P>0.05),SHCC的强化方式在应用两种对比剂时亦无统计学差异(P>0.05)。结论:1MRI诊断中,THPE与SHCC在形态、信号、位置及强化方式上存在差异;THPE的强化方式在应用两种对比剂时无明显差异;SHCC的强化方式在应用两种对比剂时也无明显差异。2磁共振肝胆细胞特异性对比剂Gd-EOB-DTPA,有助于THPE与SHCC的诊断及鉴别,其诊断能力较Gd-DTPA更佳。
PURPOSE: To compare the effect of Gd-DTPA, a hepatocyte-specific contrast agent, and a nonspecific extracellular gap agent, on hepatic arterial phase (THPE) and small hepatocellular carcinoma Small hepatocellular carcinoma (SHCC) for the differential diagnosis. At the same time, we analyzed the morphology, signal characteristics and enhancement characteristics of THPE and SHCC contrast agents. METHODS: Fifty-eight liver-localized arterial phase focal lesions in 46 patients with cirrhosis were analyzed by two imaging physicians. Mainly in the application of non-specific extracellular gap Gd-DTPA contrast agent and hepatocyte specific contrast agent Pomei was (Gd-EOB-DTPA) in the case of each focal lesion signal, morphological characteristics, and strengthen the enhanced scanning mode The difference, and then determine the nature of the lesion. Surgical or puncture pathology results, interventional angiography or follow-up observation of more than 6 months and other indicators as the gold standard, retrospective analysis of two contrast agents for the diagnosis and identification of hepatic THPE and SHCC. Statistical methods using chi-square test, comparison of THPE and SHCC morphology, location, signal and enhancement methods differences; comparison of THPE enhancement method in the application of two contrast agents whether there is a difference; comparison of SHCC strengthening method in the application of two Contrast agent whether there are differences. A total of 58 intra-hepatic localized arterial phase intensifying groups, 36 nodular intra-hepatic localized arterial phase intensifying groups and 23 maximal hepatic <1 cm intra-hepatic localized arterial phase intensifying groups were comparatively studied. The sensitivity and specificity of the two contrast agents were evaluated and the area under the ROC curve was calculated to compare the diagnostic efficacy of the two contrast agents. P <0.05 for the difference was statistically significant. In 39 cases of THPE, 33 cases were confirmed by follow-up in June and 6 cases were confirmed by interventional angiography. 19 cases of SHCC, 10 cases confirmed by pathology, 1 case of percutaneous liver biopsy and angiography confirmed, while the other 8 cases by angiography combined with AFP indicators confirmed. Results: Under different groups, the sensitivity, specificity and area under the ROC curve were all higher than that of gadopentetate. There was a difference in the morphology, location, signal and enhancement between THPE and SHCC (P <0.05). There was no significant difference in the enhancement of THPE between the two contrast agents (P> 0.05). There was no significant difference between the two intensifiers in SHCC enhancement mode (P> 0.05). CONCLUSIONS: There are differences in the morphology, signal, location and enhancement of THPE and SHCC in 1MRI diagnosis. There is no significant difference in the enhancement of THPE between the two contrast agents. The enhancement of SHCC in both contrast agents Significant differences. 2 magnetic resonance hepatobiliary cell specific contrast agent Gd-EOB-DTPA, contribute to the diagnosis and identification of THPE and SHCC, its diagnosis ability is better than Gd-DTPA.