分享:
分享到微信朋友圈
X
临床研究
肝脏特异性对比剂MRI优化序列在高风险人群中筛查小肝癌的价值研究
王聪 郭然 师丹丹 于长江 周怡然 朱绍成

Cite this article as: Wang C, Guo R, Shi DD, et al. Study on the value of liver-specific contrast agent MRI abbreviated sequence in screening small hepatocellular carcinoma in high-risk population[J]. Chin J Magn Reson Imaging, 2021, 12(9): 20-24.本文引用格式:王聪, 郭然, 师丹丹, 等. 肝脏特异性对比剂MRI优化序列在高风险人群中筛查小肝癌的价值研究[J]. 磁共振成像, 2021, 12(9): 20-24. DOI:10.12015/issn.1674-8034.2021.09.005.


[摘要] 目的 比较三组MRI优化序列在肝细胞性肝癌高风险人群中对小肝癌的筛查能力。材料与方法 收集2017年1月至2020年10月于河南省人民医院行全序列钆塞酸二钠增强MRI检查且有病理结果的121例患者图像,从全序列中提取三组优化序列让两位放射科医师独立评估:(1)平扫组,包括T2WI和DWI序列;(2)增强组,包括蒙片和钆塞酸二钠四期增强图像(动脉早期、动脉期、门静脉期、平衡期);(3)肝胆期组,包括T2WI、DWI和20 min T1-HBP序列。根据病理结果将患者分为肝癌阳性或阴性,计算三组优化序列诊断效能。结果 三组优化序列扫描和准备时间(min:s)分别为12:52、13:04、14:06。三组优化序列诊断小肝癌的敏感度及相应95%置信区间为0.855 (0.750、0.928)、0.913 (0.820、0.967)、0.942 (0.858、0.984);特异度为0.731 (0.590、0.844)、0.904 (0.790、0.968)、0.885 (0.766、0.956);符合率0.802 (0.719、0.869)、0.909 (0.843、0.954)、0.917 (0.853、0.960)。三组阳性似然比为3.18、9.51、8.19,阴性似然比为0.19、0.09、0.06,约登指数为0.586、0.817、0.827。结论 平扫组敏感度较高,为小肝癌筛查提供一定的帮助;增强组和肝胆期组特异度和符合率高,用于筛查小肝癌的诊断效能更好。
[Abstract] Objective To compare the screening ability of three groups of abbreviated MRI sequences for small hepatocellular carcinoma (small hepatocellular carcinoma, sHCC) in a high-risk population of hepatocellular carcinoma (HCC). Materials andMethods The images of 121 patients with pathological results who underwent full sequence gadoxetic acid-enhanced MR in Henan People's Hospital from January 2017 to October 2020 were collected. Three groups of optimized sequences were extracted from the whole sequence for independent evaluation by two radiologists: (1) Non-contrast group, including T2WI and DWI sequences. (2) Dynamic enhancement group, including four-phase enhanced images of disodium gadolinium (early arterial phase, arterial phase, portal venous phase, equilibrium phase). (3) Hepatobiliary phase group, including T2WI, DWI and 20 min T1-HBP sequences. According to the pathological results, the patients were divided into positive or negative liver cancer, and the diagnostic efficiency of the abbreviated sequence in the three groups was calculated.Results The scanning and preparation time of the three groups of abbreviated MRI sequences (minutes: seconds) are 12:52, 13:04 and 14:06, respectively. The sensitivity and 95% confidence interval of the three abbreviated sequences for diagnosing small hepatocellular carcinoma were 0.855 (0.750, 0.928), 0.913 (0.820, 0.967), 0.942 (0.858, 0.984), and the specificity was 0.731 (0.590, 0.844), 0.904 (0.790, 0.968), 0.885 (0.766,0.956). The coincidence rate was 0.802 (0.719, 0.869), 0.909 (0.843, 0.954), 0.917 (0.853, 0.960). The positive likelihood ratios of the three groups were 3.18, 9.51, 8.19, the negative likelihood ratios were 0.19, 0.09, 0.06, and the Youden index was 0.586, 0.817 and 0.827 respectively.Conclusions The sensitivity of non-contrast group is higher, which is helpful for small hepatocellular carcinoma screening, while the specificity and coincidence rate of dynamic enhancement group and hepatobiliary phase group are higher, and the diagnostic efficacy of screening small hepatocellular carcinoma is better.
[关键词] 小肝癌;钆塞酸二钠;磁共振优化序列;筛查;肝脏;对比剂;磁共振成像
[Keywords] small hepatocellular carcinoma;Gd-EOB-DTPA;abbreviated magnetic resonance imaging sequence;screening;liver;contrast agent;magnetic resonance imaging

王聪 1   郭然 2   师丹丹 2   于长江 2   周怡然 2   朱绍成 2*  

1 新乡医学院河南省人民医院,新乡 453003

2 河南省人民医院医学影像科,郑州 450003

朱绍成,E-mail:zsc2686@163.com

全体作者均声明无利益冲突。


基金项目: 河南省重点研发与推广专项(科技攻关) 212102310729
收稿日期:2021-04-05
接受日期:2021-06-29
DOI: 10.12015/issn.1674-8034.2021.09.005
本文引用格式:王聪, 郭然, 师丹丹, 等. 肝脏特异性对比剂MRI优化序列在高风险人群中筛查小肝癌的价值研究[J]. 磁共振成像, 2021, 12(9): 20-24. DOI:10.12015/issn.1674-8034.2021.09.005.

       肝细胞性肝癌(hepatocellular carcinoma,HCC)是人类第四大常见癌症,也是恶性肿瘤死亡相关的第二大主要原因[1]。肿瘤的分期决定了患者的预后[2, 3],对肝癌高风险人群进行筛查,尽早发现小肝细胞性肝癌(small hepatocellular carcinoma,sHCC)是提高生存率最有效的方法。在一项前瞻性随机对照试验中,每6个月对患者使用血清甲胎蛋白和超声进行一次筛查使肝癌病死率降低了37%[4]。许多国际组织和协会建议对HCC高风险人群用超声实施筛查与监测。然而,超声对小肝癌的筛查效果不高,其敏感性低至47%~63%[5],尤其在肥胖、中重度脂肪肝、Child-Pugh B级患者中可视化差,敏感度更低[6]。因此,急需一种诊断效能高、临床应用方便、安全无辐射的影像检查方法用于高风险人群小肝癌的筛查。

       在一项比较超声、CT和MRI的研究中,三者对每个患者检测肝癌的敏感度分别为64%、76%和85%[7]。与超声相比,在肝癌高风险人群中,使用肝脏特异性对比剂钆塞酸二钠(Gd-EOB-DTPA)的MRI可提高HCC检出率,并降低假阳性率[8]。与CT和MRI相比,Gd-EOB-DTPA增强MRI能够提高HCC检测的诊断准确度(80%、94%、98%)[9],因为它有独特的肝胆特异期(hepatobiliary phase images,HBP),在注射Gd-EOB-DTPA 10~20 min后扫描得到的即为肝胆特异期图像,在HBP中,正常功能的肝实质明显强化,肝功能减退、正常功能肝细胞减少或缺乏的病变部分表现为低信号,对直径小于20 mm的病变,诊断准确度提高更显著[10, 11]。不可否认的是,全序列Gd-EOB-DTPA MR扫描时间长,价格高昂,作为常规筛查手段性价比并不高。笔者拟从完整的Gd-EOB-DTPA增强MRI (complete MRI)中提取部分序列,组成三组不同的优化MRI序列(abbreviated MRI,aMRI),评估三组优化序列对高风险人群筛查sHCC的诊断效能并作出比较,以期找到高性价比的sHCC早期筛查技术。

1 材料与方法

1.1 临床资料及研究对象

       本研究经过河南省人民医院医学伦理委员会批准[批准文号:(2018)伦审第(69)号],免除受试者知情同意。回顾性分析本院自2017年1月至2020年10月因肝脏疾病行Gd-EOB-DTPA MRI检查的患者资料,纳入标准:(1)属于肝细胞性肝癌高风险人群[中国临床肿瘤学会(CSCO) 2019版《原发性肝癌诊疗指南》],包括由各种原因引起肝硬化者、HBV/HCV感染、长期酗酒、非酒精性脂肪性肝炎、食用被黄曲霉毒素污染的食物、有HCC家族史等;(2)在进行MRI检查前未接受任何手术或放化疗;(3)检查后1个月内行手术或肝穿刺取得病理结果。排除标准:(1)已知有原发肝外恶性肿瘤病史者;(2)严重图像伪影;(3)任一病变直径>3 cm者。根据病理结果,将患者分为sHCC阳性和阴性。符合以上标准的121例患者最终纳入本研究,sHCC阳性69例,年龄(56.1±8.8)岁;sHCC阴性52例,年龄(46.7±13.1)岁。

1.2 MRI技术

       采用美国GE Discover MR 750 3.0 T磁共振扫描设备,专用8通道相控阵表面线圈,采集腹部MRI,线圈中心置于剑突水平,扫描范围覆盖膈肌至肝脏下缘。被检者空腹6 h以上并签署对比剂注射知情同意书。采用肝脏特异性对比剂Gd-EOB-DTPA (普美显,德国拜耳医药保健有限公司)经肘静脉用高压注射器以1.0 mL/s的流速推注,剂量为0.025 mmol/kg。之后,立即注射等量的生理盐水进行冲洗。扫描序列为常规T1WI(蒙片)、Gd-EOB-DTPA四期增强扫描(动脉早期、动脉期、门静脉期、平衡期)、冠位LAVA序列、冠位单次激发快速自旋回波(SSFSE)序列、轴位T2WI脂肪抑制序列、扩散加权成像(DWI)序列、肝胆特异期序列(注射对比剂后3 min、5 min、10 min、15 min、20 min)。常规T1WI及增强扫描采用肝脏快速容积采集成像序列,扫描参数为TR 3.7 ms,TE 1.7 ms,翻转角11°,矩阵:320×192,FOV 380 mm×304 mm,层厚5 mm。从完整序列的Gd-EOB-DTPA增强扫描图像中重建优化MRI序列(abbreviated MRI,aMRI)相对应的扫描时间见表1

表1  重建aMRI方案相应的扫描时间(min:s)
Tab. 1  Scan time for rebuilding aMRI scheme (min:s)

1.3 图像分析及处理方法

       所有患者图像传送至PACS系统。从完整序列中提取三组优化序列图像,分别是:(1)平扫组(Nc-aMRI),包括T2WI和DWI序列图像;(2)增强组(Dyn-aMRI),包括蒙片和Gd-EOB-DTPA四期增强(动脉早期、动脉期、门静脉期、平衡期)图像;(3)肝胆期组(HBP-aMRI),包括T2WI、DWI和20 min T1-HBP序列图像。所有患者三组优化序列图像随机分配给2名主治医师以上职称的放射科医生,2名医生在不了解病理和影像报告的前提下,独立对每位患者三组优化序列图像进行诊断并记录,诊断结果不一致时经由第3名高年资放射科医生诊断并记录。将全部最终诊断结果与金标准进行比较。

       平扫组和肝胆期组,采用超声肝脏影像报告与数据系统(US Li-Rads)改编的肝癌筛查综合评分系统[12]对患者图像进行评分:阴性是指无病变或肯定是良性病变;阈下是指≥1个结节直径<10 mm;阳性是指≥1个结节直径≥10 mm且不能诊断为肝硬化、囊肿或血管瘤等病变。HCC在各序列的信号特征:(1) T2WI高信号病变,提示囊肿或血管瘤的亮信号除外;(2) DWI病变扩散受限,定义为b=0和(或) b=50 s/mm2的DWI上与肝实质相比呈轻度至中度高信号,b=500 s/mm2和(或)b=800 s/mm2处持续高信号;(3) HBP明显低信号,与周围肝实质相比信号强度降低。当≥1个病变评分为阳性时,认为患者是sHCC阳性;当未发现病变或评分为阈下时,认为患者是sHCC阴性。增强组,HCC的影像学特征[13]为:(1)病灶动脉期呈不均匀高信号,门脉期、平衡期廓清;(2)乏血供时动脉期及门脉期呈等或低信号,平衡期呈低信号。有上述病灶的患者诊断为sHCC阳性,否则为sHCC阴性。

1.4 统计学分析

       应用SPSS 25.0软件,采用均数±标准差表示符合正态分布的计量资料。2名医生诊断结果进行Kappa一致性检验,根据《医学统计学》第4版(人民卫生出版社),Kappa值在0.81~1.00之间,一致性很好;在0.61~0.80之间,一致性较好;在0.41~0.60之间,一致性中等;在0.21~0.40之间,一致性一般;在0~0.20之间,一致性差,P<0.05为差异有统计学意义。以病理结果为金标准,计算三组优化序列的敏感度、特异度、符合率及其95%置信区间,使用McNemar检验比较三组优化序列的诊断效能,P<0.05为差异具有统计学意义。计算阳性似然比、阴性似然比、约登指数评估三组优化序列的筛查效果和真实性。

2 结果

2.1 观察者间一致性

       经Kappa一致性检验,平扫组Kappa=0.808,P<0.001;增强组Kappa=0.899,P<0.001;肝胆期组Kappa=0.881,P<0.001,2名医生诊断结果一致性很好(图1, 2, 3, 4, 5, 6, 7, 8)。

图1~8  男,46岁。乙型肝炎肝硬化合并肝癌,病灶位于肝左叶,直径30 mm。蒙片(图1)示稍等T1信号(箭),增强动脉期(图23)明显强化(箭),门脉期(图4)及平衡期(图5)信号逐渐减低(箭),轴位T2WI (图6,箭)显示病灶高信号,扩散加权成像(图7)呈中度扩散受限(箭),肝胆特异期(图8)病灶呈低信号(箭)。2名医生分别在独立提取的平扫组、增强组和肝胆期组一致将其正确诊断为肝细胞性肝癌
Fig. 1—8  Male, 46 years old. Hepatitis B cirrhosis complicated with liver cancer, the focus was located in the left lobe of the liver, the diameter of 30 mm. Mask (fig.1, arrow) showed slightly iso-T1 signal intensity, obvious enhancement in arterial phase (fig.2, 3; arrow), gradual decrease in signal intensity in portal vein phase (fig.4, arrow) and equilibrium phase (fig.5, arrow), and high signal intensity in axial T2WI (fig.6, arrow), DWI (fig.7, arrow) showed moderate diffusion limitation, HBP (fig.8, arrow). Hepatocellular carcinoma (HCC) was correctly diagnosed by 2 doctors in the independently extracted Non-contrast group (Nc-aMRI), Dynamic enhancement group (Dyn-aMRI) and hepatobiliary phase group (HBP-aMRI).

2.2 三组优化序列诊断效能的McNemar检验

       三组优化序列最终诊断结果相较金标准诊断实现的敏感度、特异度和符合率及其95%置信区间数据见表2

表2  三组优化序列诊断效能比较(%)
Tab. 2  Comparison of diagnostic performance of three abbreviated sequences (%)

2.3 三组优化序列的阳性似然比、阴性似然比、约登指数

       具体统计见表3

表3  三组优化序列阳性似然比、阴性似然比、约登指数
Tab. 3  Comparison of positive likelihood ratio, negative likelihood ratio, youden index of three abbreviated MRI sequences

3 讨论

3.1 肝脏特异性对比剂优化序列筛查肝细胞性肝癌的意义

       目前,诊断肝细胞性肝癌仍以肝脏活检结果作为金标准,但肝活检是一种有创性检查,不宜重复,可能造成肝肿瘤播散风险,并不适用于高风险人群的筛查[14]。不同学者提出从全序列Gd-EOB-DTPA MR扫描中提取部分序列作为优化方案,Besa等[15]分析了T1WI、T2WI、DWI、HBP图像单独或联合应用对肝细胞性肝癌的诊断效能,结果表明DWI和HBP图像对肝细胞性肝癌的检出具有较高的敏感度和阴性预测值,与全序列MRI相比成本降低了30.7%~49.0%。Whang等[16]通过比较平扫序列(T2WI、T1正反相位、DWI、ADC图)与肝胆期序列(T2WI、20 min T1-HBP、DWI、ADC图),两组对肝细胞性肝癌表现出相似的诊断效能。先前的研究病例中包括肝癌的早、中、晚期患者,中晚期患者肿瘤体积大,易转移并侵犯各组织器官。因此缩小研究范围,早期发现无症状的小肝癌更有利于提高生存率。以往优化序列的研究重心仅在于肝胆特异期,未涉及动态增强期与肝胆期对肝癌诊断效能的横向对比。本研究聚焦小肝癌,设计三组不同期相优化序列,比较并评估三组针对高风险人群筛查小肝癌的应用价值。

3.2 三组不同优化序列筛查小肝癌的意义和价值

       本研究中,共使用三组优化序列,分别是平扫组,增强组,肝胆期组。如表1所示,三组优化序列扫描和准备时间(min:s)在12:52~14:06之间,一次完整的Gd-EOB-DTPA增强扫描大约需要40 min,保守估计未来如果只进行优化序列扫描的筛查方案所需时间与之相比减少一半,如此一来提高了磁共振仪器的利用率,并为患者和医师节约了大量时间。平扫组在筛查小肝癌时敏感度为85.5%,低于肝胆期组,特异度和符合率低于其他两组(P<0.05)。Park等[17]研究表明,平扫MRI较超声具有更高的敏感度与特异度,本组的结果与之相符。虽然平扫组对病变检出率较其他2组相对较低,但是其无需注射对比剂,不存在与对比剂相关的风险,说明平扫MRI或许有能力作为sHCC备选的筛查方案。

       增强组和肝胆期组敏感度、特异度和符合率均较高,三者在两组之间比较差异无统计学意义(P>0.05)。增强组进行筛查时可以获取HCC在增强过程中典型的强化图像,提高诊断特异度,这是平扫组和肝胆期组都无法实现的。本研究增强组的特异度90.4% (79.0%~96.8%)略低于以往的研究(94%,91%~96%)[18],这可能与研究人群不同有关。本研究的入组患者所有病变直径≤3 cm,包括非HCC病变及良性病变者,这项标准在其他研究中未被限定。经分析,造成增强组假阳性的病变大多数是结节性肝硬化,这类病变在影像学上的特征与sHCC存在一定的交织,本身就易与之混淆。入组患者病灶小,且良性病变有病理结果的例数较少,因而相对降低了本研究的特异度,在后续研究中可以开展大样本研究进一步提高诊断特异度。若以增强组作为小肝癌的筛查方案,需要在扫描室内高压静脉推注对比剂进行动态图像采集,考验患者的憋气能力,易产生呼吸运动伪影,是使用时需要考虑的不足。

       肝胆期组中,由于有肝胆特异期的加持,结合平扫序列明显提高了对小肝癌的诊断效能,Tillman等[19]研究表明,包含肝胆期的优化序列对病变的敏感度与阴性预测值更高,本研究结果与前人[19, 20, 21]的研究结果一致。肝胆期组无需采集动态图像,可以一次性注射对比剂,进一步降低成本,方便静脉注射困难的患者进行扫描,有极大的潜力成为全序列MRI的低成本替代方案。本研究中三组MRI优化序列的阳性似然比分别为3.18、9.51、8.19,阴性似然比0.19、0.09、0.06,约登指数0.586、0.817、0.827,说明三组方案为高风险人群筛查sHCC时效果较好,真实性较高。Goossens等[22]研究同样表明,风险分层的HCC监测策略,即超声用于低风险组,MRI用于高风险组具有成本效益,并且在所有患者中都优于不分层的半年一次的超声。

       综上所述,平扫组敏感度较高,为筛查小肝癌提供一定帮助;与平扫组相比,增强组和肝胆期组在小肝癌筛查中表现出更好的诊断效能,对临床早期筛查与诊断小肝癌有更高的应用价值。

3.3 研究的局限与不足

       第一,本研究所有的扫描流程是基于单中心的GE Discover MR750 3.0 T磁共振设备,使用其他设备时产生的结果可能与之有出入;第二,本研究人群中sHCC患病率比实际诊疗环境中高,可能会导致高估优化序列的诊断效能;第三,回顾性研究也是缺陷之一,将来要进行前瞻性多中心随机对照研究。

[1]
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in Globocan 2012[J]. Int J Cancer, 2015, 136(5): E359-386. DOI: 10.1002/ijc.29210.
[2]
Izzo F, Piccirillo M, Albino V, et al. Prospective screening increases the detection of potentially curable hepatocellular carcinoma: results in 8,900 high-risk patients[J]. HPB(Oxford), 2013, 15(12): 985-990. DOI: 10.1111/hpb.12080.
[3]
Tseng PL, Wang JH, Tung HD, et al. Optimal treatment increased survival of hepatocellular carcinoma patients detected with community-based screening[J]. J Gastroenterol Hepatol, 2010, 25(8): 1426-1434. DOI: 10.1111/j.1440-1746.2010.06285.x.
[4]
Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma[J]. J Cancer Res Clin Oncol, 2004, 130(7): 417-422. DOI: 10.1007/s00432-004-0552-0.
[5]
Tzartzeva K, Obi J, Rich N, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: a Meta-analysis[J]. Gastroenterology, 2018, 154(6): 1706-1718.e1. DOI: 10.1053/j.gastro.2018.01.064.
[6]
Milot L. Does Hepatocellular Carcinoma Screening with US Work? Using the US LI-RADS Algorithm[J]. Radiology, 2019, 292(2): 398-399. DOI: 10.1148/radiol.2019191105.
[7]
Yu NC, Chaudhari V, Raman SS, et al. CT and MRI improve detection of hepatocellular carcinoma, compared with ultrasound alone, in patients with cirrhosis[J]. Clin Gastroenterol Hepatol, 2011, 9(2): 161-167. DOI: 10.1016/j.cgh.2010.09.017.
[8]
Kim S, An J, Lim Y, et al. MRI with liver-specific contrast for surveillance of patients with cirrhosis at high risk of hepatocellular carcinoma[J]. JAMA Oncol, 2017, 3(4): 456-463. DOI: 10.1001/jamaoncol.2016.3147.
[9]
Imbriaco M, De Luca S, Coppola M, et al. Diagnostic accuracy of gd-eob-dtpa for detection hepatocellular carcinoma (HCC): a comparative study with dynamic contrast enhanced magnetic resonance imaging (MRI) and dynamic contrast enhanced computed tomography (CT)[J]. Pol J Radiol, 2017, 82: 50-57. DOI: 10.12659/PJR.899239.
[10]
曹亮, 李瑞, 张倩, 等. 钆塞酸二钠在肝细胞肝癌诊断及评估中的应用进展[J]. 磁共振成像, 2020, 10(11): 943-946. DOI: 10.12015/issn.1674-8034.2020.10.028.
Cao L, Li R, Zhang Q, et al. Progress of Gd-EOB-DTPA in the diagnosis and evaluation of HCC[J]. Chin J Magn Reson Imaging, 2020, 10(11): 943-946. DOI: 10.12015/issn.1674-8034.2020.10.028.
[11]
Rao SX, Wang J, Wang J, et al. Chinese consensus on the clinical application of hepatobiliary magnetic resonance imaging contrast agent: Gadoxetic acid disodium[J]. J Dig Dis, 2019, 20(2): 54-61. DOI: 10.1111/1751-2980.12707.
[12]
Morgan TA, Maturen KE, Dahiya N, et al. US Li-Rads: ultrasound liver imaging reporting and data system for screening and surveillance of hepatocellular carcinoma[J]. Abdom Radiol (NY), 2018, 43(1): 41-55. DOI: 10.1007/s00261-017-1317-y.
[13]
中华医学会放射学分会腹部学组. 肝胆特异性MRI对比剂钆塞酸二钠临床应用专家共识[J].中华放射学杂志, 2016, 9(50): 641-646. DOI: 10.3760/cma.j.issn.1005-1201.2016.09.001.
Abdominal Division of Radiology Society of Chinese Medical Association. Expert consensus on clinical application of hepatobiliary- specific MRI contrast agent Gd-EOB-DTPA[J]. Chin J Radiol, 2016, 9(50): 641-646. DOI: 10.3760/cma.j.issn.1005-1201.2016.09.001.
[14]
Di Tommaso L, Spadaccini M, Donadon M, et al. Role of liver biopsy in hepatocellular carcinoma[J]. World J Gastroenterol, 2019, 25(40): 6041-6052. DOI: 10.3748/wjg.v25.i40.6041.
[15]
Besa C, Lewis S, Pandharipande PV, et al. Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid[J]. Abdom Radiol (NY), 2017, 42(1): 179-190. DOI: 10.1007/s00261-016-0841-5.
[16]
Whang S, Choi MH, Choi JI, et al. Comparison of diagnostic performance of non-contrast MRI and abbreviated MRI using gadoxetic acid in initially diagnosed hepatocellular carcinoma patients: a simulation study of surveillance for hepatocellular carcinomas[J]. Eur Radiol, 2020, 30(8): 4150-4163. DOI: 10.1007/s00330-020-06754-4.
[17]
Park HJ, Jang HY, Kim SY, et al. Non-enhanced magnetic resonance imaging as a surveillance tool for hepatocellular carcinoma: comparison with ultrasound[J]. J Hepatol, 2020, 72(4): 718-724. DOI: 10.1016/j.jhep.2019.12.001.
[18]
Gupta P, Soundararajan R, Patel A, et al. Abbreviated MRI for hepatocellular carcinoma screening: a systematic review and meta-analysis[J]. J Hepatol, 2021, 75(1): 108-119. DOI: 10.1016/j.jhep.2021.01.041.
[19]
Tillman BG, Gorman JD, Hru JM, et al. Diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI protocol for hepatocellular carcinoma screening[J]. Clin Radiol, 2018, 73(5): 485-493. DOI: 10.1016/j.crad.2017.11.013.
[20]
Marks RM, Ryan A, Heba ER, et al. Diagnostic per-patient accuracy of an abbreviated hepatobiliary phase gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance[J]. AJR Am J Roentgenol, 2015, 204(3): 527-535. DOI: 10.2214/AJR.14.12986.
[21]
Bashir MR, Gupta RT, Davenport MS, et al. Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis?[J]. J Magn Reson Imaging, 2013, 37(2): 398-406. DOI: 10.1002/jmri.23818.
[22]
Goossens N, Singal AG, King LY, et al. Cost-effectiveness of risk score-stratified hepatocellular carcinoma screening in patients with cirrhosis[J]. Clin Transl Gastroenterol, 2017, 8(6): e101. DOI: 10.1038/ctg.2017.26.

上一篇 心脏磁共振成像评价肥厚型心肌病左心室乳头肌形态学改变的初步研究
下一篇 基于2018版肝脏影像报告及数据系统评估CT及MRI对小于等于3cm肝细胞性肝癌的诊断价值
  
诚聘英才 | 广告合作 | 免责声明 | 版权声明
联系电话:010-67113815
京ICP备19028836号-2