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(Department of Radiology, the First Hospital of Lanzhou University, Lanzhou 730000, China)

Progresses of CAIPIRINHA-Dixon-TWIST-VIBE in diagnosis of small hepatocellular carcinoma

MAWenting,LIJinkui,ZHAIYa'nan,GUOShunlin,LEIJunqiang*

(DepartmentofRadiology,theFirstHospitalofLanzhouUniversity,Lanzhou730000,China)

Early small hepatocellular carcinoma (SHCC) can be cured by surgery and interventional operation to improve the survival rate of paitents, so the accurate diagnosis of SHCC is of great significance. Presently, the dynamic contrast-enhanced MR scan could only obtain single arterial phase imaging by single breath-hold, and it had breathing motion artifact because of the long scanning time. The early arterial transient enhancement of SHCC was easy to be misdiagnosed. The CAIPIRINHA-Dixon-TWIST-VIBE (CDT-VIBE) sequence could obtain high-quality multiple arterial phases images and hepatic arterial dominant (HAD) images in short-time scanning. And it could not only detect small focal lesions which were difficult to find by other imaging examination, but also find the start enhanced difference between lesions which were relevant to lesions property and blood supplement. The CDT-VIBE has a high clinical value in diagnosis and treatment of SHCC. The research progresses of CDT-VIBE in diagnosis of SHCC was reviewed in this article.

Liver neoplasms； Carcinoma, hepatocellular； Magnetic resonance imaging； Sequence

肝细胞肝癌(hepatocellular carcinoma， HCC)是常见的恶性肿瘤，发病率为全身恶性肿瘤的第6位[1]，死亡率为第3位[2]，中晚期HCC术后复发率高达69%～75%[3]，中位生存时间仅11.8个月[4]。虽然通过外科手术切除及局部射频消融术可根治早期小肝癌(small hepatocellular carcinoma， SHCC)[5]，显著提高患者生存率，但其病灶体积小，肿瘤供血动脉尚未完全形成，易被常规MR增强扫描漏诊。我国80%以上的SHCC发生于乙型肝炎肝硬化基础上[6]，影像诊断困难，因此提高影像学诊断准确率，减少漏诊率非常重要。SHCC诊断及鉴别诊断主要依靠动脉期图像，而目前动态增强扫描只能行动脉单期成像，SHCC可因扫描时机不适而被漏诊。CAIPIRINHA-Dixon-TWIST-VIBE(CDT-VIBE)序列可完整地观察动脉期全程强化过程，捕捉动脉强化峰值，避免漏诊小病灶及一过性强化病灶，国外已将其应用于肝脏、乳腺及前列腺小病灶的诊断[7-13]。本文就CDT-VIBE序列诊断SHCC的研究进展进行综述。

1 SHCC的定义

我国SHCC诊断标准为：单个癌结节最大径≤3 cm；多个癌结节数目≤2个，最大径之和≤3 cm。国际SHCC诊断标准为：最大径≤2 cm的病灶[14]。

2 SHCC常用影像诊断技术

目前诊断SHCC常用影像技术有CEUS、增强CT(contrast-enhanced computed tomography， CECT)、DWI、MRI动态增强(dynamic contrast-enhanced MRI， DCE-MRI)、肝脏三维容积快速采集(liver acquisition with volume acceleration， LAVA)序列、容积式插入屏气检查 (volumetric interpolated breath-hold examination， VIBE)序列及CDT-VIBE序列。

Niu等[15-16]研究发现造影剂采用声诺维的CEUS诊断SHCC的准确率最高，敏感度为84%，特异度为89%，但明显低于DCE-MRI(敏感度91%，特异度96%)。Liu等[17-18]研究发现CECT与CEUS相比，对SHCC及肝硬化背景下SHCC的诊断准确率比较差异无统计学意义(P>0.05)，且CECT及CEUS诊断价值明显低于MRI。DWI是目前唯一可在分子水平反映组织功能的无创性检查，但其空间分辨率较低，易产生磁敏感伪影，无法单独检出病灶，只能作为DCE-MRI的补充序列[19-20]。D……