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目的比较多层螺旋CT(MDCT)与MRI动态增强扫描对患有慢性肝病及肝硬化患者中对小肝细胞癌(SHCC)检出的敏感性,评价不同影像技术的临床价值。方法37例纳入研究组,其中24例明确诊断SHCC,共43个病灶;MDCT快流率注射对比剂碘海醇后行多期扫描;MRI采用SE序列加快速扰相梯度回波序列(FMPSPGR),行钆喷替酸葡甲胺(Gd-DTPA)增强后动态扫描。对结果行受试者特性(ROC)曲线分析并统计检出敏感性。结果分析ROC曲线,MDCT快速注射对比剂后多期扫描对SHCC的诊断效率高于MR动态扫描,但曲线下面积Az值,两种方法间差异无统计学意义(P>0·05)。对瘤径≤1cm的微小肝癌(MHCC)检出敏感性,MDCT和MRI分别为90·0%、95·0%和70·0%、85·0%;对SHCC的阳性预测值MDCT增强后多期扫描略高于MR动态增强扫描,分别为97·5%、97·6%和90·7%、94·7%。结论对于慢性肝病及肝硬化病人的随访,建议采用MDCT增强后多期扫描,为及早发现SHCC或MHCC及早期治疗提供帮助。
Objective To compare the sensitivity of multi-slice spiral CT (MDCT) and dynamic contrast-enhanced MRI (MRI) in the detection of small hepatocellular carcinoma (SHCC) in patients with chronic liver disease and cirrhosis and to evaluate the clinical value of different imaging techniques. Methods Thirty-seven cases were enrolled in the study group, of which 24 cases were diagnosed as SHCC with a total of 43 lesions. MDCT fast flow rate contrast agent iohexol was used to perform multislice scanning. The SE sequence was used to speed up the rapid perturbation gradient echo sequence (FMPSPGR) , Line gadolinium spray acid meglumine (Gd-DTPA) enhanced dynamic scanning. ROC curve analysis was performed on the result line and statistical sensitivity was detected. Results Analysis of ROC curve and MDCT rapid contrast injection showed that the diagnostic efficiency of multislice scan for SHCC was higher than that of MR dynamic scan, but the area under the curve was Az value. There was no significant difference between the two methods (P> 0.05). The sensitivity of detection of small hepatocellular carcinoma (MHCC) ≤1cm in diameter was 90.0%, 95.0% and 70.0%, 85.0% for MDCT and MRI, respectively. The positive predictive value for SHCC was increased after MDCT The multi-phase scan was slightly higher than MR dynamic enhanced scan, 97.5%, 97.6% and 90.7%, 94.7% respectively. Conclusions For the follow-up of patients with chronic liver disease and cirrhosis, MDCT enhanced multi-phase scan is recommended, which may be helpful for early detection of SHCC or MHCC and early treatment.