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目的探讨钆塞酸二钠(Gd-EOB-DTPA)MR扫描对乙肝肝硬化背景肝癌的诊断价值。方法 32例乙肝肝硬化患者共34个肝癌病灶,均行两种MR成像[模式1:T2WI、DWI、T1WI同反相位、Gd-DTPA动态增强(平扫、动脉期、门静脉期及延迟期);模式2:T2WI、DWI、T1WI同反相位、Gd-EOB-DTPA动态增强(平扫、动脉期、门静脉期、延迟期及肝胆期)]。由2名阅片者采用双盲法分析图像,记录病灶的信号特点、强化方式及阅片者的信心评分。比较两种成像模式下阅片者诊断肝癌信心评分、一致性、ROC曲线下的面积、敏感性及阳性预测值。结果 (1)模式2下两位阅片者诊断肝癌的信心评分均提高,差异有统计学意义(P<0.05);且2名阅片者在模式2下诊断肝癌的一致性均增加。(2)2名阅片者在模式2下诊断肝癌的ROC曲线下面积均较模式1增加,差异有统计学意义(P<0.05)。(3)2名阅片者在模式2下诊断肝癌的敏感性较模式1均提高,差异有统计学意义(P<0.05),阳性预测值差异均无统计学意义(P>0.05)。结论 Gd-EOB-DTPA MR扫描有助于提高阅片者对乙肝肝硬化背景肝癌的诊断信心从而提高诊断能力。
Objective To investigate the value of Gd-EOB-DTPA MR imaging in the diagnosis of liver cirrhosis with liver cirrhosis. Methods Thirty-two HCC patients were enrolled in this study. Thirty-two HCC patients were enrolled in this study. Two kinds of MR imaging were performed in all patients with hepatitis B cirrhosis [Mode 1: T2WI, DWI, T1WI with opposite phase, dynamic enhancement of Gd-DTPA ); Mode 2: T2WI, DWI, T1WI with antiphase, Gd-EOB-DTPA dynamic enhancement (plain scan, arterial phase, portal venous phase, delayed phase and hepatobiliary phase)]. Two readers used a double-blind analysis of the image, recording the lesion’s signal characteristics, intensifying the way and the reader’s confidence score. The confidence score, agreement, area under the ROC curve, sensitivity and positive predictive value were compared between the two imaging modalities. Results (1) The confidence score of two readers in diagnosis of HCC in Mode 2 was significantly higher than that in Mode 2 (P <0.05), and the concordance of two readers in diagnosis of HCC was increased in Mode 2. (2) The area under the ROC curve of 2 readers in Mode 2 was higher than that in Mode 1, the difference was statistically significant (P <0.05). (3) The sensitivity of 2 readers in diagnosis of HCC in Mode 2 was significantly higher than that in Mode 1 (P <0.05), but the positive predictive value was not significantly different (P> 0.05). Conclusion The Gd-EOB-DTPA MR scan can improve the diagnostic ability of readers in diagnosis of liver cancer with cirrhosis of hepatitis B and improve the diagnostic ability.