钆贝葡胺与钆塞酸二钠增强MRI诊断HBV相关肝癌包膜的效能比较

doi:10.3877/cma.j.issn.2095-3232.2020.01.016

目的

比较钆贝葡胺增强MRI和钆塞酸二钠增强MRI诊断HBV相关肝细胞癌（肝癌）包膜的效能。

方法

回顾性分析2016年3月至2017年10月在中山大学附属第三医院行MRI检查的102例肝癌患者临床影像资料。患者均签署知情同意书，符合医学伦理学规定。其中男90例，女12例；平均年龄（52±10）岁。MRI检查造影剂使用钆贝葡胺54例（钆贝葡胺组），钆塞酸二钠48例（钆塞酸二钠组）。由两名经验丰富的腹部影像诊断医师进行独立盲法阅片。采用χ²检验比较钆贝葡胺和钆塞酸二钠对肝癌包膜的检出率。以病理学检查为金标准，采用受试者工作特征（ROC）曲线分析两种造影剂对肝癌包膜的诊断效能。

结果

102例肝癌患者中，73个病灶存在病理包膜，其中钆贝葡胺组45个，钆塞酸二钠组28个。钆贝葡胺增强MRI肝癌包膜检出率为89%（40/45），明显高于钆塞酸二钠的39%（11/28）（χ²=20.171，P<0.05）。钆贝葡胺诊断肝癌包膜ROC曲线下面积为0.722（95%CI：0.514～0.930），准确性83%，敏感度0.89，特异度0.56；钆塞酸二钠诊断肝癌包膜ROC曲线下面积为0.621（95%CI：0.462～0.781），准确性58%，敏感度0.39，特异度0.85。

结论

钆贝葡胺增强MRI对HBV相关肝癌包膜检出率、敏感度、准确性高于钆塞酸二钠，诊断性能较好。

关键词: 癌，肝细胞, 钆贝葡胺, 钆塞酸二钠, 磁共振成像

Objective

To compare the diagnostic efficiency between Gd-BOPTA-enhanced MRI and Gd-EOB-DTPA-enhanced MRI for HBV-related hepatocellular carcinoma (HCC) capsule.

Methods

Clinical imaging data of 102 HCC patients who underwent MRI in the Third Affiliated Hospital of Sun Yat-senUniversity from March 2016 to October 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 90 patients were male and 12 female, aged (52±10) years on average. Gd-BOPTA-enhanced MRI was performed in 54 patients (Gd-BOPTA group) and Gd-EOB-DTPA-enhanced MRI was performed in 48 cases (Gd-EOB-DTPA group). MRI images were independently assessed by 2 experienced abdominal imaging professionals who were blind to this study. The detection rate of HCC capsule between two groups was statistically compared by Chi-square test. Based on the pathological examination as the gold standard of diagnosis, the diagnostic efficiency of HCC capsule between two contrast agents was analyzed by receiver operating characteristic (ROC) curve.

Results

Among 102 HCC patients, 73 lesions had pathological capsules including 45 lesions in the Gd-BOPTA group and 28 in the Gd-EOB-DTPA group. The detection rate of Gd-BOPTA-enhanced MRI for HCC capsule was 89%(40/45), significantly higher than 39% (11/28) of Gd-EOB-DTPA-enhanced MRI (χ²=20.171, P<0.05). The area under ROC curve of Gd-BOPTA for diagnosing HCC capsule was 0.722 (95%CI:0.514-0.930), the accuracy was 83%, the sensitivity was 0.89 and the specificity was 0.56, respectively. The area under ROC curve of Gd-EOB-DTPA was 0.621 (95%CI: 0.462-0.781), the accuracy was 58%, the sensitivity was 0.39 and the specificity was 0.85, respectively.

Conclusions

Gd-BOPTA-enhanced MRI yields higher detection rate, sensitivity and accuracy than Gd-EOB-DTPA-enhanced MRI for diagnosing HBV-related HCC capsule.

Key words: Carcinoma, hepatocellular, Gd-BOPTA, Gd-EOB-DTPA, Magnetic resonance imaging

表1 钆贝葡胺组和钆塞酸二钠组肝癌患者一般资料比较

组别	例数	年龄（岁，±s）	性别（例）		AFP [μg/L，M（Q_R）]	肿瘤直径[cm，M（Q_R）]	Child-Pugh分级（例）
			性别（例）				A级	B级
			男	女			A级	B级
钆贝葡胺组	54	53±10	50	4	018（0～3 975）	32（10～114）	40	14
钆塞酸二钠组	48	50±9	40	8	104（1～4 830）	38（10～131）	36	12
统计值	?	t=1.224	χ²=20.99		Z=-0.708	Z=-0.627	χ²=0.011
P值	?	0.224	0.147		0.480	0.531	0.095

表1 钆贝葡胺组和钆塞酸二钠组肝癌患者一般资料比较

组别	例数	年龄（岁，±s）	性别（例）		AFP [μg/L，M（Q_R）]	肿瘤直径[cm，M（Q_R）]	Child-Pugh分级（例）
			性别（例）				A级	B级
			男	女			A级	B级
钆贝葡胺组	54	53±10	50	4	018（0～3 975）	32（10～114）	40	14
钆塞酸二钠组	48	50±9	40	8	104（1～4 830）	38（10～131）	36	12
统计值	?	t=1.224	χ²=20.99		Z=-0.708	Z=-0.627	χ²=0.011
P值	?	0.224	0.147		0.480	0.531	0.095

图1 肝Ⅴ/Ⅷ段高分化肝癌包膜钆贝葡胺增强MRI表现

图2 肝Ⅳ段中低分化肝癌包膜钆塞酸二钠增强MRI表现

图3 钆贝葡胺和钆塞酸二钠增强MRI诊断肝癌包膜的ROC曲线

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Comparison of diagnostic efficiency between Gd-BOPTA- and Gd-EOB-DTPA-enhanced MRI for HBV-related hepatocellular carcinoma capsule

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Comparison of diagnostic efficiency between Gd-BOPTA- and Gd-EOB-DTPA-enhanced MRI for HBV-related hepatocellular carcinoma capsule