CAJ | 학술논문

目的：探讨钆喷酸葡胺(Gd-DTPA)及钆塞酸二钠(Gd-EOB-DTPA)的磁共振动态增强扫描对肝脏结节的鉴别诊断价值。方法回顾性分析60例经 Gd-DTPA 及 Gd-EOB-DTPA 增强的肝内结节磁共振平扫、多时相动态增强扫描图像。结果所有入组病例经 Gd-DTPA 动态增强扫描后,19例患者诊断为原发性肝细胞癌,并经病理证实；8例确诊为肝转移瘤；18例诊断为肝内良性结节,随访3~6个月结节大小无明显变化。15例鉴别诊断困难的患者行 Gd-EOB-DTPA 多时相动态增强扫描,4例动脉期明显强化,门脉期强化程度迅速下降,平衡期轻度强化,肝特异性期与正常肝实质比较呈等信号,后证实为肝腺瘤；7例动脉期轻到中度强化,门脉期强化程度下降,平衡期强化不明显,肝特异性期与正常肝实质比较呈低信号,经随访或病理确诊为肝细胞癌；3例动脉期表现为轻度强化,门脉期及平衡期略强化,肝特异性期与正常肝实质比较呈低信号,根据其病史诊断为转移瘤；1例动脉期病变周边明显强化,门脉期强化程度迅速下降,平衡期轻度强化,肝特异性期与正常肝实质比较呈等信号,病变中心始终呈低信号,经复查诊断为肝良性病变。结论Gd-DTPA 动态增强 MRI 扫描对诊断肝内结节性病灶具有重要作用,Gd-EOB-DTPA 在鉴别结节的良恶性方面具有较大优势。
목적：탐토구분산포알(Gd-DTPA)급구새산이납(Gd-EOB-DTPA)적자공진동태증강소묘대간장결절적감별진단개치。방법회고성분석60례경 Gd-DTPA 급 Gd-EOB-DTPA 증강적간내결절자공진평소、다시상동태증강소묘도상。결과소유입조병례경 Gd-DTPA 동태증강소묘후,19례환자진단위원발성간세포암,병경병리증실；8례학진위간전이류；18례진단위간내량성결절,수방3~6개월결절대소무명현변화。15례감별진단곤난적환자행 Gd-EOB-DTPA 다시상동태증강소묘,4례동맥기명현강화,문맥기강화정도신속하강,평형기경도강화,간특이성기여정상간실질비교정등신호,후증실위간선류；7례동맥기경도중도강화,문맥기강화정도하강,평형기강화불명현,간특이성기여정상간실질비교정저신호,경수방혹병리학진위간세포암；3례동맥기표현위경도강화,문맥기급평형기략강화,간특이성기여정상간실질비교정저신호,근거기병사진단위전이류；1례동맥기병변주변명현강화,문맥기강화정도신속하강,평형기경도강화,간특이성기여정상간실질비교정등신호,병변중심시종정저신호,경복사진단위간량성병변。결론Gd-DTPA 동태증강 MRI 소묘대진단간내결절성병조구유중요작용,Gd-EOB-DTPA 재감별결절적량악성방면구유교대우세。
Objective To probe the value of two MR contrasts (Gd-DTPA and Gd-EOB-DTPA)in differential diagnosis of hepatic nodules. Methods 60 patients with different hepatic lesions underwent plain and dynamic contrast enhanced MRI (DCEMRI)with Gd-DTPA and Gd-EOB-DTPA,and the images were analyzed retrospectively.Results The MRI with Gd-DTPA revealed hepatocellular carci-noma in 1 9 patients which were confirmed by the following pathology,hepatic metastasis in 8,benign lesion in 18 which did not change obviously after 3-6 months of follow-up,and unclear diagnosis in other 1 5 patients who underwent the further MRI with Gd-EOB-DTPA.The MRI with Gd-EOB-DTPA in hepatobiliary phase revealed hepatic adenoma with isointensity in 4 patients,hep-atocellular carcinoma with hypointensity in 7 which were confirmed by following pathology or follow-up,metastasis in 3 with hy-pointensity which were confirmed by other malignances,and unclear benign lesion in 1 with isointensity and central hyperintensity which did not change after several follow-ups.Conclusion DCEMRI with Gd-DTPA plays an important role in the diagnosis of he-patic nodules,and Gd-EOB-DTPA is helpful for the differential diagnosis.