Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine-enhanced MR imaging: Prospective study
Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine-enhanced MR imaging: Prospective study
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DOI：
10.1148/radiol.2361040338
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发表时间：
2005-07-01
期刊：
影响因子：
19.7
通讯作者：
Schneider, G
中科院分区：
文献类型：
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作者：
Grazioli, L;Morana, G;Schneider, G
目得：为了前瞻性地确定使用钆贝酸二甲胺增强磁共振（MR）imaging区分良性局灶性结节性增生（FNH）与肝腺瘤（HA）和肝腺瘤病（LA）的准确性，MATERIALS AND METHODS：伦理委员会在每个中心批准了这项研究，所有患者提供了知情同意书。73例确诊为FNH的患者和35例确诊为HA（n = 27）或LA（n = 8）的患者在术前接受了MR成像（T2加权半傅立叶快速采集伴弛豫增强或T2加权快速自旋回波和T1加权梯度回波[GRE]序列）和25-30秒时在（仅T1加权GRE序列，有或没有脂肪抑制）推注施用0.1 mmol/kg体重的钆贝葡胺之后，在（动脉期）、70-90秒（门静脉期）、3-5分钟（平衡期）和1-3小时（延迟期）观察了10 - 15分钟（动脉期）、10 - 15秒（门静脉期）、3-5分钟（平衡期）和1-3小时（延迟期）。评估了235个病灶（128个FNH，32个HA和75个LA病灶）相对于正常肝实质的增强。鉴别FNH与HA和LA的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和总体准确性被确定。结果：在199个病灶中，177个（88.9%）病灶在未增强图像上可见，T2加权图像上为高信号和等信号，T1加权图像上为等信号和低信号。在造影剂注射后的动态期图像上，235个病灶中的231个（98.3%）在动脉期显示快速强增强，在门静脉期和平衡期显示高至等信号。仅根据造影前或动态相位图像不可能准确区分FNH与HA和LA。在造影剂增强后1-3小时，128个FNH中有124个（96.9%）表现为高或等信号，而107个（100%）HA和LA病变表现为低信号。FNH与HA和LA鉴别诊断的敏感性、特异性、PPV、NPV和总体准确性分别为96.9%、100%、100%、96.4%和98.3%，respectively.CONCLUSION：钆贝葡胺给药后延迟T1加权GRE图像可准确鉴别FNH与HA和LA。(c)RSNA，2005年。
PURPOSE: To prospectively determine the accuracy of differentiating benign focal nodular hyperplasia (FNH) from hepatic adenoma (HA) and liver adenomatosis (LA) by using gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging.MATERIALS AND METHODS: The ethics committee at each center approved the study, and all patients provided informed consent. Seventy-three patients with confirmed FNH and 35 patients with confirmed HA (n = 27) or LA (n = 8) underwent MR imaging before (T2-weighted half-Fourier rapid acquisition with relaxation enhancement or T2-weighted fast spin-echo and T1-weighted gradient-echo [GRE] sequences) and at 25-30 seconds (arterial phase), 70-90 seconds (portal venous phase), 3-5 minutes (equilibrium phase), and 1-3 hours (delayed phase) after (T1-weighted GRE sequences only, with or without fat suppression) bolus administration of 0.1 mmol per kilogram of body weight gadobenate dimeglumine. The enhancement of 235 lesions (128 FNH, 32 HA, and 75 LA lesions) relative to the normal liver parenchyma was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for the differentiation of FNH from HA and LA were determined.RESULTS: Hyper- and isointensity on T2-weighted and iso- and hypointensity on T1-weighted GRE images were noted for 177 (88.9 %) of 199 lesions visible on unenhanced images. On dynamic phase images after contrast material administration, 231 (98.3 %) of 235 lesions showed rapid strong enhancement during the arterial phase and appeared hyper- to isointense during portal venous and equilibrium phases. Accurate differentiation of FNH from HA and LA was not possible on the basis of precontrast or dynamic phase images alone. At 1-3 hours after contrast material enhancement, 124 (96.9 %) of 128 FNHs appeared hyper- or isointense, while 107 (100 %) HA and LA lesions appeared hypointense. The sensitivity, specificity, PPV, NPV, and overall accuracy for the differentiation of FNH from HA and LA were 96.9 %, 100 %, 100 %, 96.4 %, and 98.3 %, respectively.CONCLUSION: Accurate differentiation of FNH from HA and LA is achievable on delayed T1-weighted GRE images after administration of gadobenate dimeglumine. (c) RSNA, 2005.