| Objective: summarize the different characters of morphology and signal of Transient Hepatic Parenchymal Enhancement(THPE)and small hepatocellular carcinoma(SHCC)on MRI imagings,and the respenctive characters of enhancement with two different MRI contrast agents,and further discuss the value and ability of gadoliniumethoxybenzyldiethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging in diagnosis and distinguishing of THPE and SHCC.Methods: two experienced imaging diagnostic doctors with more than 5 years' experience analyze the imagings characters of the 58 focal intensity regions(THPEs 39,SHCCs 19)in 46 patients with liver cirrhosis(male 27,female 19).Analysis focuses on morphology,signal and the pattern of enhancement in different phases(referring to the signal of surrounding liver parenchyma,to make sure the intensity changes of the lesions)with Gd-DTPA and Gd-EOB-DTPA repectively,sequences includes T1 WI,T2WI and every phase of contrast T1 WI including hepatic phase.And then to infer the property of every focal intensity region synthetically(if the two doctors have controversy on the diagnosis,then the result base on the one after debate).Retrospectively,analyse the ability of two contrast agents in diagnosing and distinguishing THPE and small hepatocellular carcinoma.Use chi-square test to compare differences of shape,location,signal and pattern of enhancement between THPE and s HCC,compare if there is difference in enhancement pattern of THPE with the two MRI contrast agent,and compare if there is difference in enhancement pattern of s HCC with the two MRI contrast agent,and figure out sensitivities,specificities and AUCs(area under curve)of ROCs of the twoagents in total 58 focal intensity regions,36 nodualr focal intensity regions and focal intensity regions of maximum diameter<1cm respectively,then analyze the difference of diagnostic results.If the P<0.05,the difference have statistical significance.Among 39 THPEs,there are 33 cases are confirmed by 6 months' following up,others are confirmed by angiography.Among 19 s HCCs,there are 10 cases are confirmed by postoperational pathology,there is 1 case is confirmed by percutaneous biopsy and angiography,and other 9 cases are confirmed by combining analysis of angiography and AFP.Results: THPES and SHCCs have differentiation in shape,location and signal and pattern of enhancement,and the enhancement pattern of THPE shows no statistical difference between using two different MRI contrast agent.The enhancement pattern of s HCC shows no statistical difference between using two different MRI contrast agent too.By the analysis of the tow doctors,The result show that among the 58 focal intensity regions inour research,with Gd-DTPA,the sensitivity is 87.2%,the specificity is 97.4% and the AUC is 0.857,while with Gd-EOB-DTPA the sensitivity is 92.3 %,the specificity is 94.7% and the AUC is 0.935,the results have statistical difference,so GdEOB-DTPA showed a higher accuracy.To 36 focal intensity regions(19 THPEs,17 SHCCs),with Gd-DTPA,the sensitivity is 73.3%,the specificity is 82.4% and the AUC is 0.780,while with Gd-EOB-DTPA the sensitivity is 84.2%,the specificity is 94.1% and the AUC is 0.892,the results have statistical difference,so Gd-EOB-DTPA showed a higher accuracy.Among 23 focal intensity regions of those diameter<1cm,with Gd-DTPA,the sensitivity is 68.8%,the specificity is 57.1% and the AUC is 0.629,while with Gd-EOB-DTPA the sensitivity is 85.7%,the specificity is 87.5% and the AUC is 0.866,the results have statistical difference,so Gd-EOB-DTPA showed a higher accuracy,so Gd-EOB-DTPA showed better performance.Conclusion:1.THPE and s HCC have difference in shape,signal,location and pattern of enhancement,and the the two MRI contrast agent show no statistical difference in the enhancement of all focal intensity regions.2.Gd-EOB-DTPA has the value in diagnosing and differentiating THPE and SHCC,and it has a better performance than traditional contrast agent. |
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