Will CT take second billing to MR imaging for the diagnosis of hypervascular hepatocellular carcinomas hereafter?
Will CT take second billing to MR imaging for the diagnosis of hypervascular hepatocellular carcinomas hereafter?
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今后CT在诊断富血管性肝细胞癌方面是否会仅次于MR成像？
DOI：
10.1148/radiol.11110345
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发表时间：
2011
期刊：
影响因子：
19.7
通讯作者：
M. Kanematsu
中科院分区：
文献类型：
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作者：
M. Kanematsu
值得祝贺的是Di Martino博士及其同事（1）在2010年9月发表了一篇富有洞察力的放射学文章，该文章得出的结论是，钆塞酸二钠增强磁共振（MR）成像在检测肝细胞癌（HCC）方面的准确性高于64层多探测器计算机断层扫描（CT），重点是避免辐射暴露的风险。为了在肝动脉期实现对多血管肝癌的良好描述，当使用300 mg碘/mL（mg I/mL）造影剂时，注射持续时间应至少为25或30秒，造影剂剂量分别为1.7或2.0 mL/kg（2）。也就是说，需要至少20 mg I/kg/sec的部分剂量以在肝动脉期最佳地检测HCC。同时，在Di Martino博士及其同事的文章中，如果使用其参数（碘负荷，520 mg I/kg [1.3 mL/kg];患者体重，48-100 kg;注射速率，4-5 mL/sec）计算，部分剂量范围为16 - 42 mg I/kg/sec。我认为部分剂量的如此大的变异性损害了某些患者的肝动脉期图像质量。在他们的研究方案中，将通过将注射持续时间固定为26秒来实现20 mg I/kg/sec的部分剂量。Di Martino博士及其同事在触发后18秒开始动脉期扫描（1）。事实上，Dr Sultana等人（3）得出结论，肝动脉期的肿瘤-肝脏造影剂在触发后18秒达到峰值，但他们使用了25秒的固定注射持续时间，并且主动脉造影剂峰值总是在造影剂注射完成后约5秒发生。在Di Martino博士和Col...
Dr Di Martino and colleagues (1) are to be congratulated for their insightful September 2010 Radiology article, which concluded that gadoxetate disodium–enhanced magnetic resonance (MR) imaging has greater accuracy than does 64-section multidetector computed tomography (CT) for detecting hepatocellular carcinoma (HCC), with an emphasis on the avoidance of the risk of radiation exposure.To achieve excellent depiction of hypervascular HCCs during the hepatic arterial phase, injection duration should be at least 25 or 30 seconds with a contrast agent dose of 1.7 or 2.0 mL/kg, respectively, when using a 300 mg iodine per milliliter (mg I/mL) contrast agent (2). Namely, a fractional dose of at least 20 mg I/kg/sec is required to detect HCCs optimally during the hepatic arterial phase. Meanwhile, in the article by Dr Di Martino and colleagues, the fractional doses ranged from 16 to 42 mg I/kg/sec if calculated with their parameters (iodine load, 520 mg I/kg [1.3 mL/kg]; patient weight, 48–100 kg; injection rate, 4–5 mL/sec). I believe such a large variability in fractional dose impaired the quality of hepatic arterial phase images in some patients. In their study protocol, a fractional dose of 20 mg I/kg/sec will be achieved by fixing the injection duration at 26 seconds. Dr Di Martino and colleagues started arterial phase scanning 18 seconds after triggering (1). Indeed, Dr Sultana et al (3) concluded tumor-to-liver contrast during the hepatic arterial phase peaked 18 seconds after triggering, but they used a fixed injection duration of 25 seconds, and aortic peak invariably took place approximately 5 seconds after completion of contrast agent injection. In the study by Dr Di Martino and col-