人工手推法Gd-DTPA动态增强对小肝癌MRI诊断.docVIP

人工手推法Gd-DTPA动态增强对小肝癌MRI诊断 　 作者;田旭玉，陈建波，张暹东，李茂林，王丽凤，兰 岚 ［摘要］ 目的 探讨人工手推注射法Gd-DTPA动态增强MRI对小肝癌的诊断价值。方法 搜集16例（21个病灶）经临床和病理证实的小肝癌MR扫描资料，包括平扫及人工手推法动态增强扫描。结果 平扫T2WI多呈高信号，T1WI多呈低信号，少数呈等或高信号。23.81％可见假包膜。MRI平扫与动态增强对小肝癌诊断的准确率分别66.67％和95.24％(Plt;0.05)。结论 人工手推法Gd-DTPA动态增强较平扫MRI能提高小肝癌的定性准确率。 ［关键词］ 人工注射法；动态增强；磁共振扫描；小肝癌 Evaluation of dynamic contrast-enhanced MRI by manual injection in the diagnosis of small HCC ［Abstract］ Objective To study the diagnostic value of dynamic gadolinium-enhanced MR imaging in small hepotacellular carcinoma (SHCC) by manual injection.Methods The scan date by MRI of 16 cases (21 lesions) with SHCC confirmed by pathology clinic were reviewed，include plain scan and dynamic contrast-enhanced scan by manual injection.Results On plain scan，most SHCC showed hyperdensity on T2WI.Most SHCC showed hypodensity and a few showed isodensity or hyperdensity on T1WI.Pseudocapsule can be detected in 23.81% cases.On dynamic-enhanced MRI，17 lesions were hypervascular and 4 lesions were hypovascular.Pesudocapsule can be detected in 57.14% cases.The diagnostic accuracy of plain MRI scan and the Gd-DTPA dynamic-enhanced MRI on SHCC were 66.67% and 95.24% (Plt;0.05).Conclusion Compared with plain scan，Gd -DTPA dynamic-enhanced MRI by manual injection can promote the diagnostic accuracy of SHCC. ［Key words］ manual injection;dynamic enhancement;MRI;SHCC 肝细胞癌是较常见的恶性肿瘤，近年来随着影像诊断方法尤其是MRI动态增强扫描的发展，小肝癌（≤3 cm）的检出率不断提高，对延长患者的生存期起到了积极作用。但由于MRI检查费用本身很高，而非磁性高压注射器成本高，使患者经济负担加重，限制了动态增强扫描的使用，因此笔者应用人工快速手推注射造影剂Gd-DTPA的方法行MRI动态增强扫描获得了很好的效果。 1 资料与方法 1.1 一般资料 本组16例，男11例，女5例，年龄33~78岁，平均51岁。16例中10例经手术病理证实，4例经穿刺活检病理证实，2例经DSA证实。16例中14例有明确的乙型肝炎病史。12例为单发病灶，3例有两个病灶，1例有三个病灶，共发现病灶21个，病灶大小为1.2~3.0 cm。 1.2 人工手推注射Gd-DTPA方法 取2支20 ml注射器（分别抽取造影剂和生理盐水）及九号头皮针头，用三通连接后经肘静脉建立静脉通道，先注射生理盐水约5 ml以保证静脉通畅，然后快速推注造影剂，注射速率2~3 ml/s，推注时间5~10 s，药量0.2 ml/kg，总药量≤20 ml，造影剂注射完毕后将剩余生理盐水以同速注入冲管。 1.3 扫描方法 采用GE公司signa 1.5 T超导型MR成像仪，体部8通道柔软相控阵表面（TORSOPA）线圈，呼吸门控，常规扫描包括T1WI、T2WI及脂肪抑制序列。动态增强扫描患者单次屏气12 s完成1 h相共76幅图像的扫描