Application Of Gd-EOB-DTPA In Hepatic Nodular Lesions

Objective: The incidence rate of primary liver malignancies ranks sixth in the world and the third in mortality.The incidence rate of primary hepatic malignancies in China ranks fifth in all tumors,with a mortality rate of second.Early diagnosis of liver cancer is very difficult,patients usually have cirrhosis background,patients have no specific symptoms in the early stage,small liver cancer and cirrhosis nodules are not easy to distinguish,usually need to use one or more imaging methods for early detection and accurate diagnosis of liver regeneration nodules.However,when the nodule is less than 2 cm,the qualitative diagnosis of the disease becomes very difficult.Early diagnosis can significantly improve the prognosis of liver cancer,improve the survival rate,and improve the quality of life of patients.As a new noninvasive imaging technique,Gd-EOB-DTPA enhanced magnetic resonance imaging(MRI)can significantly improve the detection rate of liver cancerous nodules or small liver cancer,especially for liver cancer ≤ 1.0cm in diameter.The purpose of this study is to explore which signals of Gd-EOB-DTPA MRI can improve the early diagnosis rate of liver nodular lesions,non-invasive evaluation of liver reserve function,and can evaluate the curative effect and prognosis.In addition,Gd EOB DTPA MRI signal intensity changes were used to further evaluate the benefits of immunotherapy.Materials and methods: 388 patients with hepatic nodular lesions who underwent Gd-EOB-DTPA MRI scanning from 2016 to 2020 were retrospectively analyzed.The final diagnosis was made by surgery,liver biopsy histopathology,multiple imaging evaluation,clinical index evaluation or long-term follow-up.Gd-EOB-DTPA MRI and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-DTPA MRI)were performed to obtain the images of arterial phase,portal vein phase and transitional phase,and then the hepatobiliary phase(HBP)images of Gd-EOB-DTPA MRI were added.The images were observed and the signal intensity of the lesion area(HSI)and the surrounding liver parenchyma(PSI)were measured at each stage.The data were statistically analyzed by SPSS21.0 software.Siemens Magnetom Verio 1.5T MRI scanner was used.Results:1.There were 252 males(64.95%)and 136 females(35.05%)with an average age of 59 ± 1.93;Primary liver cancer accounted for 47.94%(186 /388),metastatic carcinoma 21.13%(85 / 388);In benign diseases,cirrhosis accounted for 17.53%(68 / 388),hepatic hemangioma accounted for 7.73%(30/388),Hepatic adenoma accounted for 0.78%(3/388),hepatic abscess accounted for 0.78%(3 / 388),fatty liver accounted for 2.84%(11 / 388),focal nodular hyperplasia(FNH)accounted for 0.78%(3 / 388),and arteriovenous short circuit accounted for 0.52%(2 / 388);Among them,41patients(28 males(68.3%)and 13 females(31.7%),aged 59 ± 33,the minimum age was 24 years old,the maximum age was 28 years old)received additional Gd-DTPA MRI.2.There was no significant correlation between age and signal intensity;Other indexes were correlated with signal intensity in varying degrees: except albumin,bilirubin,alkaline phosphatase and transaminase levels were negatively correlated with signal intensity.In addition,the history of hepatitis,past medical history,symptoms or signs at the time of treatment and complications(mainly ascites and splenomegaly)can affect the signal intensity of Gd-EOB-DTPA MRI in varying degrees,and the most significant impact on PSIR.The signal intensity of Gd-EOB-DTPA with or without hepatitis history and complications is the most important.The signal intensity of Gd-EOB-DTPA with hepatitis history or complications is lower than that without hepatitis or complications.3.There was a significant negative correlation between Signal enhancement ratio of liver parenchyma(PSIR)and Child Pugh grade of liver function(Child-Pugh A: 0.71 ± 0.436(CI95% 0.65-0.774);Child-Pugh B: 0.55 ± 0.386(CI95% 0.49-0.612);Child-Pugh C:0.42 ± 34(CI95%0.3305-0.518),correlation coefficient-0.264,P < 0.05).4.Compared with Gd-DTPA MRI,the accuracy of Gd-EOB-DTPA MRI in the diagnosis of liver nodular disease was significantly improved,and the detection rate of liver nodular disease was 11.2% higher than that of Gd-DTPA MRI.After adding HBP images,Gd-EOB-DTPA MRI found another 52 lesions,the detection rate of lesions increased by 34%,which played a good role in guiding the follow-up treatment.5.The use of ROC curve to determine whether the signal intensity of Gd-EOB-DTPA MRI can be used as a method of judging liver benign and malignant tumors confirmed that the magnetic resonance signal intensity can make a preliminary diagnosis of benign and malignant liver nodular lesions.The results showed that the cut-off values of The lesions were relatively enhanced during plain scan(HSIN)and Signal enhancement ratio of lesions(HSIR)were 0.435 and 0.445,respectively,and their sensitivity and specificity for differentiating benign and malignant liver diseases were63.20% and 71.10%,77.4% and 52.60%,respectively.In the ROC comparison of the two signal intensities,the HSIN curve is closest to the upper left corner and the area under the curve is the largest,indicating that it has the highest value in distinguishing benign and malignant liver diseases.6.According to the image comparison results,HSIR and PSIR values showed a negative correlation with the prognosis level,that is,with the increase of the prognosis level,the signal enhancement ratio showed a downward trend,and the difference was statistically significant;Similarly,there was a significant negative correlation between the signal difference before and after immunotherapy,and the difference of signal intensity before and after immunotherapy was significantly different among the prognosis grading groups,P < 0.05.Conclusions:1.There is a significant correlation between signal intensity PSIR and child Pugh classification,which can be used as a noninvasive index to judge the state of liver function.2.After adding HBP images,Gd-EOB-DTPA MRI has higher diagnostic efficiency and more sensitive lesion detection rate than Gd-DTPA MRI.3.The ROC curve can be used to make a preliminary diagnosis of benign and malignant liver nodule lesions through the intensity of Gd-EOB-DTPA MRI signals.In the comparison of the two signal strengths of HSIN and HSIR,HSIN has the highest value in differentiating benign and malignant liver diseases.4.There was a negative correlation between HSIR,PSIR and prognosis grade,that is,with the increase of prognosis grade,signal enhancement ratio decreased.Therefore,Gd-EOB-DTPA MRI examination before and after treatment of liver cancer can play a role in judging treatment measures and evaluating prognosis.5.In the patients receiving immunotherapy,the changes of signal intensity HSIR and PSIR before and after treatment also showed a significant negative correlation with the prognosis.This is not only a preliminary evaluation of the effect of immunotherapy,but also reflects the applicability of immunotherapy.Therefore,Gd-EOB-DTPA MRI examination can increase the benefits of patients who need immunotherapy.