慢性肝病肝功能正常或Child-Pugh A级患者增强CT与
普美显增强MRI诊断HCC流出征象观察期相选择

doi:10.12117/jccmi.2018.11.004

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摘要目的：比较慢性肝病肝功能正常或Child-Pugh A级患者增强CT与普美显增强MRI门静脉期、延迟期/过渡期观察流出征象对肝细胞癌（HCC）的诊断准确性。方法：回顾性分析2015年1月—2017年7月病理证实为HCC、非HCC病灶的肝功能正常或Child-Pugh A级患者的术前影像资料，包括行CT增强检查者83例，普美显MRI增强者54例。2名影像医师在同一工作站上观察每个病灶的动脉期强化、门静脉期和延迟期/过渡期流出特征。采用Mann-Whitney检验比较增强CT检查组与普美显增强MRI组年龄及病灶大小的差异；采用Kappa检验分析两位阅片者病变征象评估的一致性；采用卡方检验或Fisher精确概率法比较两组性别、病灶病理结果分布以及各种不同种类病灶的动脉期强化特征差异；采用ROC曲线比较两组门静脉期、延迟期/过渡期流出征象对HCC的诊断性能。结果：两组间不同种类病灶病理结果分布情况、动脉期强化特征均无差异。增强CT组动脉期强化联合门静脉期流出征象诊断HCC的AUC值为0.910（敏感度：85.14%，特异度：96.77%），联合延迟期流出征象诊断HCC的AUC值为0.849（敏感度：89.19%，特异度：80.65%），差异无统计学意义（Z=1.701，P=0.089 0）。普美显增强MRI组动脉期强化联合门静脉期流出征象诊断HCC的AUC值为0.853（敏感度：76.09%，特异度：94.44%），联合过渡期流出征象诊断HCC的AUC值为0.729（敏感度：84.78%，特异度：61.11%），两者差异有统计学意义（Z=2.023，P=0.043 1）。结论：慢性肝病肝功能正常或Child-Pugh A级患者增强CT门静脉期与延迟期观察流出征象诊断HCC的准确性无差异，普美显增强MRI门静脉期观察流出征象比过渡期诊断HCC更准确。

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	樊璐璐1
	谢双双2
	张坤2
	李清2
	沈文2

关键词 ：癌, 肝细胞, 体层摄影术, 螺旋计算机

Abstract：Objective: To compare the diagnostic performance of washout appearance on portal venous phase or delayed phase(transitional phase) for hepatocellular carcinoma(HCC) between gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced MRI and contrast enhanced CT in patients with chronic liver disease and normal liver function or Child-Pugh grade A. Methods: Retrospective analysis of preoperative imaging data of patients with normal liver function or Child-Pugh grade A and pathologically confirmed HCC or non-HCC lesions from January 2015 to July 2017, including 83 patients with contrast enhanced CT and 54 patients with Gd-EOB-DTPA-enhanced MRI, was performed. The arterial phase enhancement and portal venous, and delayed/transitional phase washout appearance of each lesion were observed and recorded by two radiologists on the same workstation. The Mann-Whitney test was used to compare the differences in age and lesion size between contrast enhanced CT and Gd-EOB-DTPA-enhanced MRI groups. The Kappa test was used to analyze the consistency of characteristic evaluation of each lesion between two radiologists. The Chi-Square test or Fisher’s exact test was used to compare the sex distribution, pathological results, and arterial phase enhancement characteristic of different lesions. ROC curve was performed to compare the diagnostic performance of arterial phase enhancement combined with washout appearance in portal venous and delayed/transitional phase for HCC between two groups. Results: There was no statistical difference in the distribution of pathological results and the enhancement characteristics of arterial phase between the two groups(P all >0.05). In the contrast enhanced CT group, the AUC value of diagnosis HCC was 0.910 when the arterial phase enhancement combined with washout appearance on portal venous phase(sensitivity: 85.14%, specificity: 96.77%), and the AUC value was 0.849 when arterial phase enhancement combined with washout appearance on delayed phase(sensitivity: 89.19%, specificity: 80.65%), the difference of the AUC values was not statistically significant(P=0.089 0). In Gd-EOB-DTPA-enhanced MRI group, the AUC of diagnosing HCC value was 0.853 when the arterial phase enhancement combined with washout appearance of portal venous phase(sensitivity: 76.09%, specificity: 94.44%), and the AUC value was 0.729 when the arterial phase enhancement combined with washout appearance in transitional phase(sensitivity: 84.78%, specificity: 61.11%), and the difference of AUC values was statistically significant(P=0.043 1). Conclusion: In patients with chronic liver disease and normal liver function or Child-Pugh grade A, washout appearance observed on portal venous and delayed phase for HCC have similar diagnostic accuracy on contrast enhanced CT, but washout appearance observed on portal venous are more accurate than transitional phase on Gd-EOB-DTPA-enhanced MRI.

Key words： Carcinoma, hepatocellular Tomography, spiral computed

收稿日期: 2018-08-11

PACS:	Ｒ735.7
	Ｒ814.42

基金资助:国家自然科学基金（81671657）；天津市卫生计生委科技基金（15KG133）。

通讯作者: 沈文，天津市第一中心医院放射科，300192。E-mail：shenwen66happy@163.com

作者简介: 樊璐璐（1993-），女，山西运城人，在读硕士研究生。E-mail：2466370916@qq.com

引用本文:

樊璐璐1，谢双双2，张坤2，李清2，沈文2. 慢性肝病肝功能正常或Child-Pugh A级患者增强CT与普美显增强MRI诊断HCC流出征象观察期相选择[J]. 中国临床医学影像杂志, 2018, 29(11): 775-781.
FAN Lu-lu1, XIE Shuang-shuang2, ZHANG Kun2, LI Qing2, SHEN Wen2. Phase selection for observing washout appearance in diagnosing hepatocellular carcinoma in contrast enhanced CT and Gd-EOB-DTPA-enhanced MRI for chronic liver disease patients with normal liver function or Child-Pugh grade A. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(11): 775-781.

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http://www.jccmi.com.cn/CN/10.12117/jccmi.2018.11.004 或 http://www.jccmi.com.cn/CN/Y2018/V29/I11/775

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