钆塞酸二钠增强MRI在结直肠癌肝转移术前评估中的价值

Gadoxetic Acid Disodium-Enhanced MRI in the Preoperative Evaluation of Colorectal Cancer Liver Metastases

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中文摘要：目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI对结直肠癌肝转移(CRCLM)术前评估的临床价值.资料与方法收集2019年 9 月—2023年3 月河南中医药大学第一附属医院56例CRCLM患者,经手术病理确诊共156个CRCLM病灶,均行肝脏Gd-EOB-DTPA动态增强MRI检查.观察T2WI、扩散加权成像(DWI)、动脉期和肝胆期(HBP)的特征表现,并计算各序列的检出率,计算HBP病灶与肝实质信号强度比和表观扩散系数(ADC).比较HBP呈反靶征、靶征的病灶与HBP呈均匀、不均匀低信号病灶的ADC值和各序列检出率的差异.结果 20.51%(32/156)的病灶T2WI呈靶样外观、38.46%(60/156)呈均匀高信号,51.28%(80/156)的病灶DWI呈靶征,73.72%(115/156)动脉期呈环形强化,34.62%(54/156)HBP呈靶征.HBP呈反靶征、靶征病灶与HBP呈均匀、不均匀低信号病灶的平均ADC值比较,差异无统计学意义[(0.98±0.43)×10-3 mm2/s比(1.01±0.47)×10-3 mm2/s;t=-0.340,P=0.327].依据CRCLM的病灶大小分为<1.0 cm、1.0～2.0 cm和>2.0 cm组,分别有41、55、60个病灶.与T2WI、DWI、Gd-EOB-DTPA四期动态增强比较,HBP的总检出率(96.79%)最高(P均<0.05).当CRCLM病灶<1.0 cm时,HBP的检出率(87.80%)高于T2WI、DWI和Gd-EOB-DTPA四期动态增强的检出率(P均<0.05).结论 Gd-EOB-DTPA增强MRI对CRCLM术前评估具有重要临床价值,尤其是特异性的HBP靶征或反靶征,以及HBP对CRCLM微小病灶优异的检出效能.

外文摘要：Purpose To investigate the clinical value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced MRI for the preoperative evaluation of colorectal cancer liver metastases(CRCLM).Materials and Methods Fifty-six CRCLM patients with 156 CRCLM lesions confirmed by surgical pathology in the First Affiliated Hospital of Henan University of Chinese Medicine from September 2019 to March 2023 were collected,and all underwent dynamic Gd-EOB-DTPA-enhanced MRI.The characteristic manifestations of T2WI,diffusion-weighted imaging(DWI),arterial phase and hepatobiliary phase(HBP)were observed,and the detection rate of each sequence was calculated,and then the signal intensity ratio of lesions to liver parenchyma on HBP and the apparent diffusion coefficient(ADC)were calculated.The ADC values of lesions with reversed target and target signs and lesions with homogeneous and heterogeneous hypointensity on HBP and the detection rate of each sequence were compared.Results Among 156 CRCLM lesions,20.51%(32/156)and 38.46%(60/156)exhibited a target appearance on T2WI,51.28%(80/156)displayed a target sign on DWI,73.72%(115/156)showed rim enhancement on the arterial phase,and 34.62%(54/156)presented a target sign on HBP.The mean ADC value of lesions with reversed target and target signs on HBP did not significantly differ from that of lesions with homogeneous and heterogeneous hypointensity on HBP[(0.98±0.43)×10-3 mm2/s vs.(1.01±0.47)×10-3 mm2/s;t=-0.340,P=0.327].Based on the size of CRCLM lesions,three groups were categorized,including<1.0 cm(41 lesions),1.0-2.0 cm(55 lesions),and>2.0 cm(60 lesions).The overall detection rate of HBP(96.79%)was the highest compared with T2WI,DWI and Gd-EOB-DTPA four-phase dynamic contrast-enhanced multiphase imaging(P<0.05).Regarding<1.0 cm lesions,the detection rate of HBP(87.80%)was superior to that of T2WI,DWI and Gd-EOB-DTPA four-phase dynamic contrast-enhanced multiphase imaging(P<0.05).Conclusion Gd-EOB-DTPA-enhanced MRI has important clinical value for the preoperative evaluation of CRCLM,especially the features of target sign or reversed target sign on HBP and the excellent efficacy of detecting microscopic lesions.

外文关键词：

Colorectal neoplasmsLiver neoplasmsNeoplasm metastasisMagnetic resonance imagingGadolinium ethoxybenzyl diethylenetriamine pentaacetic acidHepatobiliary phaseDiffusion-weighted imaging

作者：

张嘉诚、韩鼎盛、何旭、许倩、时付坤、张岚

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作者单位：

河南中医药大学影像医学与核医学系,河南郑州 450046

河南中医药大学第一附属医院MRI科,河南中医药大学中医药信息智能分析与利用郑州市重点实验室,河南郑州 450000

关键词：

结直肠肿瘤肝肿瘤肿瘤转移磁共振成像钆塞酸二钠肝胆期扩散加权成像

基金：

河南省医学科技攻关计划河南省自然科学基金面上项目医学科学研究基金科研项目(2022)SKY影像科研基金发展项目

项目编号：

LHGJ20230679232300421187YWJKJJHKYJJ-BXS5-22039Z-2014-07-2101

出版年：

2024

DOI：

10.3969/j.issn.1005-5185.2024.03.011

中国医学影像学杂志

中国医学影像技术研究会

中国医学影像学杂志

CSTPCD北大核心

影响因子：1.37

ISSN：1005-5185

年,卷(期)：2024.32(3)

参考文献量22