Gd-EOB-DTPA增强扫描前后T2WI对肝脏局灶性病变检出情况的比较

蔡华崧伍玲周丽莎罗宴吉翟凤仪冯仕庭李子平郑可国

【摘要】目的比较肝脏局灶性病变患者行MRI检查时于注射钆塞酸二钠(Gd-EOB-DTPA)前、后进行T2加权像(T2WI)扫描对病灶检出情况的差异。方法比较84例肝脏局灶性病变(包括肝细胞癌、局灶性结节增生、肝转移瘤及肝血管瘤)患者Gd-EOB-DTPA增强扫描前、后进行T2WI扫描的病灶检出情况、病灶信号噪声比及病灶-肝脏噪声比。结果Gd-EOB-DTPA增强扫描后T2WI的肝细胞癌、局灶性结节增生、肝转移瘤及肝血管瘤的检出评分均稍高于增强扫描前T2WI，但比较差异均无统计学意义(P均>0.05)。Gd-EOB-DTPA增强扫描前肝细胞癌、局灶性结节增生、肝转移瘤及肝血管瘤的病灶信号噪声比依次为7.65±0.35、6.13±0.74、7.83±0.49、16.69±0.52，增强扫描后依次为7.27±0.38、5.78±0.70、7.32±0.45、12.37±0.42，比较差异均有统计学意义(P均<0.001)；Gd-EOB-DTPA增强扫描前肝细胞癌、局灶性结节增生、肝转移瘤及肝血管瘤的病灶-肝脏噪声比依次为2.14±0.37、1.02±0.65、2.33±0.51、13.07±0.49，增强扫描后依次为3.46±0.35、2.06±0.61、4.28±0.47、9.11±0.52，比较差异均有统计学意义(P均<0.001)。结论对于肝细胞癌、局灶性结节增生、肝转移瘤及肝血管瘤患者，在接受MRI检查时，于Gd-EOB-DTPA增强扫描后行T2WI扫描对病灶的检出无明显影响，可在上述病变动态增强扫描后进行T2WI以节省扫描时间。

【关键词】钆塞酸二钠；T2加权像；磁共振

收稿日期：(2015-05-31)

DOI:10.3969/g.issn.0253-9802.2015.10.006

基金项目：广东省科技计划项目(2013B021800185)；广东省科技第一批企业研发与升级改造项目(2013B021800178)

通讯作者，曾锦，E-mail:13710678633@139.com

Comparison of T2-weighted MR image in detection of focal liver lesions before and after administration of Gd-EOB-DTPACaiHuasong,WuLing,ZhouLisha,LuoYanji,ZhaiFengyi,FengShiting,LiZiping,ZhengKeguo.DepartmentofRadiology,theFirstAffiliatedHospitalofSunYat-senUniverisity,Guangzhou510080,China

Correspondingauthor,ZhengKeguo,E-mail:zheng-keguo@163.com

Abstract【】ObjectiveTo compare the T2-weighted image (T2WI) in the detection of focal hepatic lesions before and after administration of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA). MethodsEighty four patients diagnosed with focal liver lesions (hepatocellular carcinoma, focal nodular hyperplasia, liver metastasis neoplasm and hepatic hemangioma) underwent T2WI. The detection capability, signal-to-noise ratio (SNR) and lesion-liver contrast to noise ratio (CNR) before and after administering Gd-EOB-DTPA were statistically compared. ResultsThe detection scores of hepatocellular carcinoma, focal nodular hyperplasia, liver metastasis neoplasm and hepatic hemangioma after Gd-EOB-DTPA-enhanced T2WI were only slightly higher than those before the administration of Gd-EOB-DTPA without statistical significance(all P>0.05). The SNR of hepatocellular carcinoma, focal nodular hyperplasia, liver metastasis neoplasm and hepatic hemangioma before Gd-EOB-DTPA-enhanced T2WI were 7.65±0.35,6.13±0.74,7.83±0.49 and 16.69±0.52, significantly higher compared with 7.27±0.38, 5.78±0.70, 7.32±0.45 and 12.37±0.42 after Gd-EOB-DTPA-enhanced T2WI (all P<0.001). The CNR of hepatocellular carcinoma, focal nodular hyperplasia, liver metastasis neoplasm and hepatic hemangioma before Gd-EOB-DTPA-enhanced T2WI were 2.14±0.37, 1.02±0.65, 2.33±0.51 and 13.07±0.49, significantly lower than 3.46±0.35, 2.06±0.61, 4.28±0.47 and 9.11±0.52 following Gd-EOB-DTPA-enhanced T2WI (all P<0.001). ConclusionGd-EOB-DTPA-enhanced T2WI exerted no apparent effect upon the detection of focal liver lesions in patients diagnosed with hepatocellular carcinoma, focal nodular hyperplasia, liver metastasis neoplasm and hepatic hemangioma, so T2WI can be performed following Gd-EOB-DTPA-enhanced scan to shorten the time of examine.

【Key words】Gdolinium ethoxybenzyl diethylenetriamine pentaacetic acid; T2-weighted image;

Magnetic resonance imaging

钆塞酸二钠(Gd-EOB-DTPA) 是一种新型的肝胆特异性MRI对比剂，是钆与乙氧基苯甲基螯合物的二钠盐[1-3]。临床研究表明，经静脉注射后，Gd-EOB-DTPA可提供与其他钆螯合物相媲美的鉴别诊断信息，约50%的Gd-EOB-DTPA被肝细胞特异性摄取后经胆道排泄，利用此特性，可提高局灶性肝脏病变的检出率[4-6]。Gd-EOB-DTPA不仅和传统的钆喷酸葡胺(Gd-DTPA)一样，能通过动态增强扫描评价肿瘤的血流灌注，而且其肝细胞吸收特性及高T1弛豫率，使肝脏在注射Gd-EOB-DTPA后30 min甚至更长时间仍能表现为高信号[7-8]。

目前，国内外公认的Gd-EOB-DTPA增强扫描肝细胞期为注药后20 min[9-10]。在实……