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目的明确增强检查动脉期对诊断小肝癌(<3cm)的重要性;评估MR动态增强减影技术在肝癌高风险病人肝小结节(<3cm)检出中的额外价值。方法 86例病人共135个病理证实的肝小结节(<3cm),其中HCC104个,良性结节31个,所有病人在进行外科根治术前均进行MRI检查。动脉期增强的判断方法有3种:①单独动脉期的视觉评估;②平扫与动脉期的视觉比较;③减影影像的再评估。每种方法的诊断结果通过广义估计方程进行统计学分析和比较。结果增强动脉期对小肝癌的诊断具有很高的阳性预测值(PPV),达到96.5%~98.9%,特异度为90.3%~96.8%,但阴性预测值较低,为54.6%~62.5%,中间敏感度为76%~79.8%。减影影像具有最高的诊断价值。3种方法的统计学处理准确性、PPV及NPV方面差异有显著性(准确度P=0.044,PPVP<0.001,NPVP=0.024),而特异度方面差异没有统计学意义(P=0.167)。结论增强检查动脉期对肝癌小结节的准确检测很重要,而减影影像则可能进一步提高其准确率。要点①动脉期强化小结节高度提示恶性肿瘤。②动态减影影像有助于提高动脉期强化的准确性。③减影影像有助于肝癌的早期诊断。④可能使病人更及时地接受治疗。
Objective To clearly emphasize the importance of examining the arterial phase in the diagnosis of small hepatocellular carcinoma (<3 cm) and to evaluate the value of MR dynamic enhancement subtraction in the detection of small hepatic nodules (<3 cm) in high-risk liver cancer patients. Methods A total of 135 pathologically confirmed liver nodules (<3cm) were obtained from 86 patients, including 104 HCCs and 31 benign nodules. All patients underwent MRI before radical surgery. There are three ways to judge the arterial phase enhancement: ① visual evaluation of individual arterial phase; ② visual comparison of plain scan and arterial phase; ③ re-evaluation of subtraction image. The diagnostic results for each method were statistically analyzed and compared using the generalized estimation equation. Results The enhanced arterial phase had a high positive predictive value (PPV) for the diagnosis of small hepatocellular carcinoma with a specificity of 90.3% -96.8%, but the negative predictive value was 54.6% -62.5% The intermediate sensitivity is 76% ~ 79.8%. Subtraction images have the highest diagnostic value. The statistical accuracy of the three methods was statistically significant (P = 0.044, PPVP <0.001, NPVP = 0.024) for PPV and NPV, but no significant difference in specificity (P = 0.167). Conclusions It is very important to enhance the accurate detection of small nodules during the examination of the arterial phase, while subtraction images may further improve the accuracy. Key points ① arterial phase enhanced nodule height prompted malignant tumors. ② dynamic subtraction images help to improve the accuracy of arterial phase. ③ subtraction images help early diagnosis of liver cancer. ④ may make patients more timely treatment.