| Objective:To analyze the imaging findings of small hepatocellular carcinoma (diameter <2cm)in contrast-enhanced ultrasound and Gd-EOB-DTPA enhanced MR imaging, and compare the diagnostic accuracy differences of small hepatocellular carcinoma (diameter<2cm) between the two examinations.Materials and methods:From January2011to May2013,48patients who were pathologically confirmed having hepatocellular carcinoma (male31cases, female17cases, average age53±10.8years) had a total of57lesions.Inclusion criteria:1. all patients were undergone CEUS(Contrast-enhanced ultrasound), Gd-EOB-DTPA(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid) enhanced MRI and CTAP (CT during arterial portography),CTHA(CT during hepaticarteriography).2.The largest diameter of lesions is less than2cm.3. The pathology of all leisions must be obtained by surgery or biopsy within30days after the imaging examination.4. The liver pathological diagnosis results are accordance with the grading standard of World Health Organization.5.All patients enrolled in this study gave informed consent for imaging examination and biopsy.This study was approved by the hospital ethics committee. According to the size, the lesions were divided into two groups:(1) diameter>lcm(23leisions),(2) lcm≤diameter<2cm (34leisions). We caculate the leision detection rate of two groups respectively, and use ROC (Receiver operating characteristics curve, ROC) curve to evaluate the accuracy of diagnosis.Results1. Imaging findings:50leisions were pathological confirmed with MHCC,2leisions were diagnosed as RN, and another5were diagnosed as DN. CEUS:39leisions showed typical "fast-in and fast-out" pattern,8lesions showed "fast-in and washout synchronous with the surrounding liver parenchyma",3leisions were enhanced synchronous with surrounding liver parenchyma,4leisions were enhanced later than the surrounding liver parenchyma in arterial phase and had a iso-enhancement with the surrounding liver parenchyma in other phases,2leisions had no enhancement in the whole process;Gd-EOB-DTPA enhanced MRI:45leisions showed typical low signal on T1WI, high signal on T2WIand low signal on hepatobiliary phase,2leisions showed high signal on T1WI, low signal on T2WI, iso-signal on hepatobiliary phase,4leisions showed iso-signal on Tl WI signal, T2WI signal and hepatobiliary phase,6leisions showed iso-signal on T1WI signal, T2WI signal and high signal on hepatobiliary phase.2. The detection of two methods:In the57lesions of48patients, a total of41MHCCs and16other liver leisions were detected by CEUS. The detection rate of CEUS was71.93%;50MHCCs and7other liver leisions were detected by Gd-EOB-DTPA-MRI. The detection rate of Gd-EOB-DTPA-MRI was87.72%. The difference was statistically significant (x2=4.412,p=0.036), in other ways, Gd-EOB-DTPA-MRI>CEUS.(1) In d<lcm group, there were23lesions. A total of12MHCCs and11other liver lesions were found by CEUS. The detection rate was52.17%. A total of19MHCCs and4other liver lesions were found by Gd-EOB-DTPA-MRI. The detection rate was82.61%. The difference was statistically significant (x2=4.847,p=0.028),in other ways, Gd-EOB-DTPA-MRI> CEUS.(2) In1≤d<2cm group, there were34lesions. A total of29MHCCs and5liver leisions were found by CEUS. The detection rate was85.29%.31MHCCs and3other liver leisions were found by Gd-EOB-DTPA-MRI. The detection rate was91.18%. The difference was not statistically significant (x2=0.567,p=0.452).3. The diagnostic accuracy of two methods:(1) in d<lcm group,20of the23lesions were pathologically diagnosed as hepatocellular carcinoma. The other3lesions were diagnosed as others.12leisions were diagnosed as MHCC and7leisions were diagnosed as others by CEUS, while19leisions were diagnosed as MHCC and4leisions were diagnosed as others by Gd-EOB-DTPA-MRI. CEUS:the diagnostic sensitivity was60%(12/20), the specificity was100%(3/3), the accuracy is52.17%(12/23), the positive predictive value was100%(12/12), the negative predictive value was27.3%(3/11); Gd-EOB-DTPA-MRI:the diagnostic sensitivity was85%(17/20), the specificity was33.3%(1/3), the accuracy was82.61%(19/23), the positive predictive value was89.47%(17/19),the negative predictive value was25%(1/4).(2) In1<d<2cm group,30of the34lesions were pathologically diagnosed as hepatocellular carcinoma. The other4lesions were diagnosed as others.30leisions were diagnosed as MHCC and4leisions were diagnosed as others by CEUS, while31leisions were diagnosed as MHCC and3leisions were diagnosed as others by Gd-EOB-DTPA-MRI. CEUS:the diagnostic sensitivity was90%(27/30), the specificity was25%(1/4), the accuracy was88.2%(30/34), the positive predictive value was90%(27/30), and the negative predictive value was25%(1/4); Gd-EOB-DTPA-MRI:the diagnostic sensitivity was93.3%(28/30), the specificity was33.3%(1/3), the accuracy was91.2%(31/34), the positive predictive value was90.3%(28/31), and negative predictive value was33.3%(1/3);4. ROC analysis of two methods:(1) in d<1cm group, area under the curve of CEUS is0.633,95%confidence interval (0.293-0.974); area under the curve of Gd-EOB-DTPA-MRI is0.758,95%confidence interval (0.00-1.00). After Z test, Z=0.376, p<0.05. The difference is statistical significance, namely Gd-EOB-DTPA-MRI> CEUS.(2) In1≤d<2cm group, area under the curve of CEUS was0.825,95%confidence interval (0.00-1.00); area under the curve of Gd-EOB-DTPA-MRI is0.842,95%confidence interval (0.00-1.00). After Z test, Z=0.376,p>0.05. The difference is statistically significant.Conclusion:CEUS and Gd-EOB-DTPA enhanced MRI both have a great value for the detection of small hepatocellular carcinoma.(1) In d<lcm group, the detection ability of Gd-EOB-DTPA-MRI is higher than that of CEUS. The detection rates were82.61%,52.17%, respectively. In1≤d<2cm group, there was no significant difference in detection ability between Gd-EOB-DTPA-MRI and CEUS. The detection rate was91.18%,85.29%, respectively.(2) In d<1cm group, the diagnostic accuracy of Gd-EOB-DTPA-MRI belongs to medium level, higher than that of CEUS (the area under the ROC curve were0.758,0.633). The difference was statistically significant. In1<d<2cm group, the diagnostic accuracy of Gd-EOB-DTPA-MRI and CEUS were a little higher than mean level (the area under the ROC curve were0.842,0.825). There was no statistically significant. |
PDF Full Text Request