钆贝葡胺双功能对比MRI对肝细胞癌LI-RADS定义征象的识别率分析

摘要

目的:探讨2014版肝脏影像报告及数据系统(LI-RADS v2014)所定义的各种征象在钆贝葡胺(Gd-BOPTA)双功能对比一站式MR成像上的识别率.方法:2013年10月-2016年9月肝硬化患者40例入组本研究,均行肝脏Gd-BOPTA双功能对比一站式MR成像(包括多期增强、平扫、扩散加权成像、肝胆期成像),且经病理证实为HCC.由两位阅片者对MR图像进行独立盲法读片,遵循LI-RADS v2014对主要征象、次要征象进行评价,计算两者对各种征象的识别率,并通过Kappa检验来分析两者对征象识别的一致性.结果:两位阅片者对HCC病灶的动脉期高强化、廓清、包膜等3个主要征象的识别率依次分别为85.7％和90.5％、78.6％和81.0％、50.0％和52.4％,阅片者间的一致性(Kappa值)分别为0.774、0.779和0.667;对于次要征象,以HCC病灶肝胆期低信号、T2WI稍高信号、扩散受限的识别率最高,分别为83.3％和81.0％、81.0％和85.7％、90.5％和85.7％,阅片者间的一致性(Kappa值)分别为0.780、0.659和0.807,而其他次要征象识别率较低,尤其在最大径＜2.0cm的小HCC中部分征象未被识别.结论:肝脏Gd-BOPTA双功能对比一站式MR成像适用于肝硬化背景下HCC的LI-RADS v2014分析.%Purpose:To evaluate the recognition rate of the liver gadobenate dimeglumine (Gd-BOPTA) dual functional contrast one-stop MR imaging features of hepatocellular carcinoma(HCC) in cirrhotic liver based on the criteria of liver imaging reporting and data system version 2014(LI-RADS v2014).Methods:From November 2013 to September 2016,40 patients with 42 HCC foci and liver cirrhosis were enrolled in this study.All the patients underwent liver Gd-BOPTA dual functional contrast one-stop MRI,including Gd-BOPTA enhanced multiphase scan,MR plain scan,diffusion weighted imaging (DWI) and hepatobiliary phase scan.They were all confirmed with HCC foci by the pathological results.Two radiologists analyzed the images independently.The readers analyzed and categorized the features of the HCC foci based on the definition given by LI-RADS v2014.The recognition rate was calculated for the major and ancillary imaging features.The Kappa test was used to assess the inter-reader agreement for all descriptive variables.Results:The recognition rates of the major features of HCC by the two radiologists were as follows:heavy enhancement in arterial phase(85.7％ and 90.5％,Kappa=0.774),"washout" appearance (78.6％ and 81.0％,Kappa=0.779),"capsule" appearance (50.0％ and 52.4％,Kappa=0.667).Most of the ancillary features could be observed,of which hypo-intense on hepatobiliary phase (83.3％ and 81.0％,Kappa=0.780),mild to moderate hyper-intensity on T2WI (81.0％ and 85.7％,Kappa=0.659) and restricted diffusion (90.5％ and 85.7％,Kappa=0.807) were more common than other features.The recognition rates of other ancillary features were low,some ancillary features were not appeared in small HCC (maximum diameter less than 2.0cm).Conclusion:The liver Gd-BOPTA dual functional contrast one-stop MRI can be used for the detection of hepatocellular carcinoma in cirrhotic liver by LI-RADS v2014.