| Section 1 The value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced T1 mapping in dysplastic nodule and hepatocellular carcinoma with different degrees of differentiationObjective: To explore the value of gadolinium-ethoxybenzyl-diethylene triamine(Gd-EOB-DTPA)enhanced MRI T1 mapping in evaluating dyspla stic nodule(DN)and hepatocellular carcinoma(HCC)with different degre es of differentiation.Materials and Methods: A retrospective study in the first affiliated Hospital of Guangxi Medical University from September 2015 to December 2017 was conducted.Seventy-one patients with HCC or DN(a total of 79 lesions)that confirmed by biopsy or surgical pathology findings.Seventy-nine lesions were divided into DN(n=10),well differentiated HCC(n=15),moderately differentiated HCC(n=36)and poorly differentiated HCC(n=18)according to histopathology.All the patients underwent plain MRI scan and Gd-EOB-DTPA-MRI T1 mapping before surgery or needle biopsy.The T1 values of each lesion and non-tumorous liver parenchyma were measured on 20 min hepatobiliary phase(HBP)T1 mapping after Gd-EOB-DTPA administration,respectively.The increment rate of T1 value in lesions relative to non-tumorous liver parenchyma were calculated.One-way ANOVA was used to compare the differences of T1 value and the increment rate of T1 value of DN and 3 groups of HCC with different degrees of differentiation.Spearman correlation was used to evaluate the correlation between T1 mapping parameters and the malignancy degree of DN and HCC.Area under the receiver operating characteristic(ROC)curves were used to evaluate the efficacy of T1 mapping parameters in the differential diagnosis of DN and HCC with different degree of differentiation.Results: Significant differences were found in T1 value and increase rate of T1 value of DN and HCC with different degrees of differentiation(P <0.05).The T1 value and increase rate of T1 value showed an increasing trend from DN to poorly differentiated HCC after enhancement.The T1 value and increase rate of T1 value were positively correlated with the malignancy of DN and HCC(r=0.418 and 0.634,P < 0.01).There were significant differences in the increase rate of T1 value between well-differentiated HCC and moderately-differentiated,well-differentiated HCC and poorly-differentiated HCC,respectively(P <0.05).The area under ROC curve of T1 value and the increase rate of T1 value for differentiating DN from well-differentiated,moderately differentiated and poorly differentiated HCC was 0.933,0.928,0.939 and 0.867,0.961,0.961,respectively(the optimal threshold were 387.7 ms?426.75 ms?426.75 ms?123.87%?123.87%?123.87%,respectively).The area under ROC curve of the increase rate of T1 value for differentiating well-differentiated HCC from moderately-differentiated,well-differentiated HCC from poorly-differentiated HCC was 0.770 and 0.844,respectively(theoptimal threshold were 244.24% and 270.55%,respectively).Conclusions:(1)After contrast-enhanced 20 min,the increasing rate of T1 and T1 values showed an increasing trend from DN to well,moderately and poorly differentiation HCC.(2)Gd-EOB-DTPA enhanced MRI T1 mapping20 min hepatobiliary phase,the optimal threshold of T1 value increase rate was123.78% for differentiating DN from well differentiation,moderately differentiation and poorly differentiation HCC,and 244.24% and 270.55% for differentiating well differentiated HCC from moderately differentiated HCC and low differentiated HCC,respectively,and the optimal threshold for T1 value increase was 244.24% and 270.55% for differentiating high differentiated HCC from moderately differentiated HCC and poorly differentiated HCC,respectively.Section 2 Evaluation of Gd-EOB-DTPA enhanced MRI T1 mapping and DWI in predicting HCC lipiodol deposition after TACEObjective: To explore the valuation of Gd-EOB-DTPA-MRI T1 mappi ng and DWI in the prediction of lipiodol deposition after TACE in hepato cellular carcinoma.Materials and Methods: This was a prospective study.HCC patients who underwent Gd-EOB-DTPA-MRI T1 mapping examination before transcatheter arterial chemoembolization in the first affiliated Hospital of Guangxi Medical University from December 2016 to December 2018 were approved by the Unit Ethics Committee.Signed informed consents were obtained from the HCC patients.A total of 37 cases were collected,and 3 patients were excluded,due to embolized with chemotherapeutic drugs polyethylene microspheres and not treated with lipiodol.A total of 34 patients(30 men and 4 women;mean age,(54.53 ± 9.81)years)with 46 lesions were included.The upper abdominal CT underwent after TACE,and lipiodol deposition was evaluated by CT.Thus,the HCC lesions with lipiodol deposition < 50% were divided into the group of lipiodol good uptake(LGU),and the HCC lesions with lipiodol deposition ?50% were divided into the group of lipiodol poor uptake(LPU).The ADC values(mm2/s)corresponding to the highest signal intensity area on DWI(b ?800s/mm2)images and T1 values of lesions and non-tumorous liver parenchyma(liver parenchyma other than 2 cm at the edge of the lesion)on hepatobiliary phase were measured.The signal intensity of lesions and liver parenchyma was measured on plain scan,arterial phase,early portal phase and hepatobiliary phase.The increment rate of T1 value in the lesions relative to non-tumorous liver parenchyma [T1(L-H)/H(%)],the lesion of arterial enhancement rate(AER),early portal veinous enhancement rate(VER)and the signal intensity ratio(SIR)of the arterial phase,early portal phase and hepatobiliary phase were calculated,respectively.T test was used to compare the above parameters for two groups of lipiodol deposits and Pearson correlation analysis was used to analyze the correlation among ADC values,T1(L-H)/H(%),AER(%),VER(%),SIRarterial phase,SIRearly portal phase,and SIRhepatobiliary phase with the uptake rate of lipiodol oil,respectively.Results: Out of 46 HCC lesions,21(45.65%)were LGU group and 25(54.35%)were LPU group.The ADC values(mm2/s)and T1(L-H)/H(%)of group of LGU and group of LPU were 940.25±156.05 and 935.72±138.7,265.77±91.72 and 173.31±94.16,respectively.The differences of T1(L-H)/H(%)between LGU group and LPU group were statistically significant(p<0.01).T1(L-H)/H(%)made a moderate positive correlation with the uptake of lipiodol in HCC(r =0.452,p < 0.01).The sensitivity and specificity of T1(L-H)/H(%)for differentiating LGU and LPU of HCC were 76.0% and 85.7%,respectively(95% IC:0.641-0.893;cut-off: 205.85%)and the area under curve(AUC)was0.878.There was no significant difference among ADC values(mm2/s)with lipiodol uptake of HCC(p > 0.05).AER(%),VER(%),SIRarterial phase,SIRearly portal phase,and SIRhepatobiliary phase were 152.78±56.81,119.71±52.62;175.30±76.50,127.65±48.82;1.43±0.35,1.04±0.38;1.14±0.19,0.83±0.21 and 0.43±0.20,0.38±0.14;respectively.Statistical significance were showed between LGU group and LPU group of AER(%),VER(%),SIRarterial phase and SIRearly portal phase(p < 0.01),AER(%),SIRarterial phase,VER(%)and SIRearly portal phase were well-moderately positive correlated with the uptake of lipiodol in HCC(r=0.295,0.477,0.360,0.607;p <0.05).The sensitivity and specificity of AER,SIR arterial phase,VER and SIR early portal phase for differentiating LGU and LPU of HCC were68.0%,66.7%;90.5%,64.0%;80.0%,66.7%;68.0%,64.0%;respectively(95%IC: 0.512-0.799,0.627-0.884,0.540-0.821,0.749-0.956,respectively;cut-off:136.42%,1.11,157.35%,0.86,respectively)and the area under curve(AUC)were 0.667,0.774,0.693,0.879,respectively.Conclusion:(1)The relevant parameters of Gd-EOB-DTPA-MRI T1 mapping,T1(L-H)/H(%),the higher of T1(L-H)/H(%),the graeter of lipiodol uptake after TACE in HCC.(2)The higher T1(L-H)/H(%),AER(%),VER(%),SIR arterial phaseand SIR early portal phase the higher the uptake rate of iodized oil;The parameter T1(L-H)/H(%),SIR arterial phase and SIR early portal phase have high diagnostic efficacy for differentiating LGU group of HCC with LPU group of HCC,and the optimal thresholds were 205.85%,1.11,0.86%,respectively.(3)The ADC value of HCC before TACE was not correlated with the uptake rate of lipiodol. |
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