| OBJECTIVE:To investigate the practical value of triple arterial phase scanning technique,dual arterial phase scanning technique and arterial single arterial phase scanning technique in Gd-EOB-DTPA-enhanced magnetic resonance imaging(MRI).METHODS:From 2015 January to 2016 July,patients in Nanjing Drum Tower Hospital who are suspected to have diagnosis of HCC by US or CT were enrolled in the study.A total of 95 patients were included and received further Gd-EOB-DTPA-enhanced MRI with Arterial phase three-phase scanning technique.We use any phase in triple arterial phase to mimic single arterial phase scanning technique and any two phase in triple arterial phase to mimic dual arterial phase scanning technique.The quality of images in different phase were evaluated.The enhancement rate of different scanning technique were compared.RESULTS:55(57.9%)cases show artifacts in early arterial phase.53(56.9%)cases show artifacts in middle arterial phase.60(63.2%)cases show artifacts in late arterial phase,There was no significant difference between the three groups(p=0.883,0.458,0.374).The occurrence of artifacts of portal-venous phase(33,34.7%),transitional phase(25,26.3%)and hepatobiliary phase(28,29.5%)was significantly lower than that of arterial phase(p=0.002,p<0.001,p<0.001).The enhancement rate of early arterial phase was 33.0%.The enhancement rate of middle arterial phase was 72.5%.The enhancement rate of late arterial phase was 74.3%.McNemar test showed that the enhancement rate of middle arterial phase and late arterial phase was significantly higher than that of early(p<0.001,p<0.001),although there was no statistically significant difference between middle arterial phase and late arterial phase(p=0.815).The enhancement rate of early and middle arterial phase was 34.9%.The enhancement rate of middle and late arterial phase was 76.1%.The enhancement rate of early and late arterial phase was 36.7%.The enhancement rate of dual arterial phase scan was higher than that of single arterial phase scan(76.1%vs.72.5%or 74.3%).But there was no significant difference between the two groups(p=0.125 or 0.500).The enhancement rate of triple arterial phase(92.7%)was significantly higher than that of middle arterial phase(92.7%vs.72.5%,p<0.001),that of late arterial phase(92.7%vs.74.3%,p<0.001)and that of dual arterial phase(92.7%vs.76.1%,p<0.001).CONCLUSION:The triple arterial phase scanning technique can significantly improve enhancement rate of arterial phase compared with dual arterial phase scanning technique and single arterial phase scanning technique in the condition of same total scan time and same image quality.The triple arterial phase scanning technique has an obvious advantage to capture the best timing of arterial phase in Gd-EOB-DTPA-enhanced MRI.OBJECTIVE:To quantitatively assess the optimal delay time of hepatobiliary phase in Gd-EOB-DTPA-enhanced magnetic resonance imaging(MRI)in patients.METHODS:We retrospectively assessed Gd-EOB-DTPA-enhanced MRI of patients with focal licer lesions.A total of 95 nodules in 77 patients were enrolled in our study.We quantitatively measured relative signal increase of liver parenchyma,the contrast-to-noise ratio(CNR)and signal-to-noise ratio(SNR)of liver nodule of hepatobiliary phase at Omin,3min,5min,10min,15min and 20min.RESULTS:Biliary contrast agent excretion was first obeserbed in about 62(80.5%)cases at 10min.The relative increase in liver parenchymal signal increased significantly from 2min to 5 min after contrast agent injection(p<0.001).It reached peak at 5 min and then decreased gradually to 20 min(p<0.001,p<0.001,p= 0.025).CNR increased significantly over time between 0 and 10 min(p<0.001,p=0.007).CNR increased slightly between 10 min and 15 min and decreased between 15 min and 20 min.Changes from 10min to 20min were not statistically significant(p=0.389,p=0.361).SNR were significantly increased after contrast agent injection(p=0.061)and peaked at 5 minutes.SNR significantly decreased between 5 and 10 minutes(p=0.001).There was no significant difference from 10min to 20 min(p=0.643,p=0.246)CONCLUSIONS:A hepatobiliary delay time of 10 min in Gd-EOB-DTPA-enhanced MRI is sufficient of liver lesion characterization in patients with normal liver function.OBJECTIVE:This study aimed to evaluate the clinical value of EASL standard and new standard(arterial-phase hyperintensity,venous-phase hypointensity and hepatobiliary-phase hypointensity)in Gd-EOB-DTPA-enhanced MRI for diagnosis of hepatocellular carcinoma.METHODS:A total of 98 patients with suspected focal hepatic nodules at surveillance of ultrasound or CT were enrolled in the study.The final diagnosis of 120 nodules in 98 patients were confirmed by pathological examination(105 hepatocellular carcinoma,8 Intrahepatic cholangiocarcinoma,1 mixed liver hepatocarcinoma,3 hemangiomas,3 angioleiomyolipomas).The diagnostic performance of findings of HCC imaging features was evaluated.We us Chi-square test to compare the performance of EASL criteria and the new criteria in Gd-EOB-DTPA-enhanced MRI for diagnosis of hepatocellular carcinoma.RESULTS:(1)The diagnostic efficacy of arterial-phase hyperintensity is highest among seven findings.The sensitivity was 75.2%(79/105)and the specificity was 66.7%(10/15).The specificity of rim enhancement in venous-phase or transitional-phase was the highest(86.7%,13/15),altough it had the lowest sensitivity(11.4%,12/105).(2)the study found that the area under the curve of the EASL criteria was 0.671(95%confidence interval 0.580-0.754)in the HCC diagnosis.The area under the curve of the new standard(arterial-phase hyperintensity,venous-phase hypointensity and hepatobiliary-phase hypointensity)was 0.652(95%confidence interval 0.560-0.737).The difference was significant(Z = 2.029>1.96).However the area under both ROC curves was less than 0.70,indicating that the diagnostic efficacy was low.CONCLUSIONS:The EASL criteria and the new criteria are not ideal in the diagnosis of HCC in Gd-EOB-DTPA-enhanced MRI.The diagnosis of liver disease cannot rely on the basic finding and the simple combination of these finding.It is important to pay attention to the dynamic changes and small details of the lesion in the Gd-EOB-DTPA-enhanced MRI. |
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