| Part Ⅰ A Prospective and Controlled Study of the Value of DSA and gadolinium injection acid meglumine MRI in the Diagnosis of Small Hepatocellular CarcinomaObjectiveTo compare the diagnostic value of hepatic artery angiography with that of gadolinium injection acid meglumine MRI for the detection of small(≤2cm)hepatocellular carcinoma(HCC)in patients.Materials and methods A total of 57 patients(age range,25–75 years,median age 51 years)with 107 HCCs(≤2 cm in diameter)who underwent both hepatic artery angiography and gadolinium injection acid meglumine MRI were enrolled in this study.Two observers independently and randomly reviewed the hepatic artery angiography and MRI images on a lesion-by-lesion basis.The diagnostic value of these techniques for the detection of HCC was assessed by Mc Nmar chi-square test,Kappa test,independent sample t-test,and response receiver operating characteristic(ROC)analysis,in addition to evaluating the detection rate.Results For the 57 patients(107 lesions),the diameter were 63 lesions with 1cm or less and 44 with greater than 1 cm.These were 91 with rich blood supply type and 16 with poor blood supply type.Of the 47 patients(88 lesions),there were confirmed by surgical resection.Of the 3 patients(4 lesions),there were confirmed by pathological biopsy,and 7 patients with 15 lesions were confirmed by transcatheter arterial chemoembolization.The detection rate of hepatic artery angiography and MRI were 86.0%(92/107)and 71.0%(76/107),respectively.The differences between the two techniques were statistically significant(P<0.05=.Of tiny HCCs with poor blood supply type,the detection rate of hepaticartery angiography and MRI were 0.1%(1/16)and 37.5%(6/16),respectively.No significant difference was seen between the detection rates for the two techniques(P>0.05).Conclusion Hepatic artery angiography shows a better diagnostic value than that of gadolinium injection acid meglumine MRI for the detection of small(≤2cm)HCCs in patients.Hepatic artery angiography is an important clinical significance for follow-up the embolism chemotherapy and accurate staging of HCCs.Part Ⅱ The Value of DSA and gadolinium injection acid meglumine MRI in Barcelona Clinic Liver Cancer of Hepatocellular CarcinomaObjective To compare the value of hepatic artery angiography with that of gadolinium injection acid meglumine MRI for the Barcelona Clinic Liver Cancer(BCLC)of hepatocellular carcinoma(HCC)in patients.Materials and methods Patients were evaluated as BCLC-A by CT examination who underwent both hepatic artery angiography and gadolinium injection acid meglumine MRI were enrolled in this study.According to MRI findings and clinical data,the subjects were divided into before and after DSA examination of BCLC.The value of two techniques for BCLC of HCC was assessed by chi-square test using SPSS 16.0.Results BCLC of DSA was consistant with MRI findings in 115 patients with HCC.In 71 of 186 pantiets were different between DSA group and MRI group to identify BCLC include 33.3%(62/186)patients were correct for DSA and4.8%(9/186)were correct for MRI.DSA was significantly superior to MRI for judgment of BCLC(P= 0.03).Conclusion Hepatic artery angiography shows a better diagnostic value than that of gadolinium injection acid meglumine MRI for BCLC of HCCs in patients.Part Ⅲ The Cost Effectiveness Analysis in the Diagnosis of Small Hepatocellular CarcinomaObjectiveToestablish the health economics evaluation model for diagnosis of small hepatocellular carcinoma.Methods107lesions were divided into DSA group and MRI group.The direct medical costs of the two groups were collected and the recurrent rate and the tumor free survival were picked up as effectiveness.Then the cost effectiveness and the incremental cost effectiveness were analyzed.At last the sensitivity analysis was also conducted.Results The cost effectiveness ratio was 69.46 yuan/% for DSAgroup while22.24 yuan/% for MRI group.Based on the MRI group,the incremental cost effectiveness ratio was 293.8 yuan/%.The results indicated if MRI change into DSA for the diagnosis of small hepatocellular carcinoma,the cost 293.8 yuan per diagnostic sensitivity.If the price of examination,materials and drug were10% reduction in this study,the cost effectiveness ratio of hepatic artery DSA was 62.55 yuan/%,while MRI was 20.04 yuan/%.Compare with MRI,the cost effectiveness ratio of hepatic artery DSA was 264.51 yuan/%.The results indicated if MRI change into DSA for the diagnosis of small hepatocellular carcinoma,the cost 264.51 yuan per diagnostic sensitivity.Conclusions For the health economics aspect,MRI for diagnosis of small hepatocellular carcinoma is the best choice.Part Ⅳ A Prospective and Controlled Study of the Value of DSA and Gadoxetic Acid-Enhanced MRI in the Diagnosis of Small Hepatocellular CarcinomaObjectiveTo compare the diagnostic value of hepatic artery angiography with that of gadoxetic acid-enhanced MRI for the detection of small(≤ 2 cm)hepatocellular carcinoma(HCC)in patients.Materials and methods A total of 42 patients(age range,31-66 years,average age 49.6±8.9 years)with 77 HCCs(≤2 cm in diameter)who underwent both hepatic artery angiography and gadoxetic acid-enhanced MRI were enrolled in this study.The examination time interval less than 2 weeks between gadoxetic acid-enhanced MRI and hepatic artery DSA.Of the 35 patients(64 lesions),there were confirmed by surgical resection.Of the 2 patients(3 lesions),there were confirmed by pathological biopsy,and 5 patients with 10 lesions were confirmed by transcatheter arterial chemoembolization.Two observers independently and randomly reviewed the hepatic artery angiography and gadoxetic acid-enhanced MR images on a lesion-by-lesion basis.The diagnostic value of these techniques for the detection of HCC was assessed by Mc Nmar chi-square test,Kappa test,independent sample t-test,and response receiver operating characteristic(ROC)analysis,in addition to evaluating the detection rate.Results For the 42 patients(77 lesions),the diameter were 42 lesions with 1 cm or less and 35 with greater than 1 cm.These were 67 with rich blood supply type were detection by hepatic artery angiography.The detection rate of hepatic artery angiography and gadoxetic acid-enhanced MRI were 87.0%(67/77)and93.5%(72/77),respectively.There was no significant difference between thetwo techniques(P > 0.05).Of tiny HCCs with poor blood supply type,the detection rate of hepatic artery angiography and gadoxetic acid-enhanced MRI were 0% and 70%,respectively.The differences between the two techniques were statistically significant(P<0.05).Conclusion Hepatic artery angiography and gadoxetic acid-enhanced MRI have a better consistency for the detection of small(≤2 cm)HCCs in patients.For poor blood supply type,gadoxetic acid-enhanced MRI shows a better diagnostic performance than that of hepatic artery angiography for the detection of small(≤2 cm)HCCs.Part Ⅴ A Prospective and Randomized Study of the Value of DSA and Gadoxetic Acid-Enhanced MRI in the Diagnosis of Small Hepatocellular CarcinomaObjective Torandomized compare the diagnostic value of hepatic artery angiography with that of gadoxetic acid-enhanced MRI for the detection of small(≤2 cm)hepatocellular carcinoma(HCC)in patients.Materials and methods A total of 123 patients(108 men,15 women;age range,20-81 years,averageage50.5±12.5 years)with 191 HCCs(≤2 cm in diameter)who underwent gadoxetic acid-enhanced MRIwas enrolled in this study.Of the103 patients(133 lesions),there were confirmed by surgical resection.Of the 9patients(24 lesions)were confirmed by transcatheter arterial chemoembolization and11 patients(34 lesions)were confirmed by imaging examination follow-up.A total of 66 patients(56 men,10 women;age range,27-78 years,averageage50.5±10.6 years)with 117 HCCs(≤2 cm in diameter)who underwent hepatic artery angiographywas enrolled in this study.Of the 34patients(44 lesions),there were confirmed by surgical resection.Of the 29patients(63 lesions)were confirmed by transcatheter arterial chemoembolization and3 patients(10 lesions)were confirmed by imaging examination follow-up.The diagnostic value of these techniques for the detection of HCC was assessed by chi-square test in addition to evaluating the detection rate.Results The detection rate of hepatic artery angiography and gadoxetic acid-enhanced MRI were91.5% and 89.5%,respectively.There was no significant difference between the two techniques(χ 2=0.29,p=0.59).For thediameter was 1 cm or less,the detection ratesof hepatic artery angiographyand gadoxetic acid-enhanced MRI were75.8% and 64.9%,respectively.No significant difference was seen between the detection rates for the two techniques(χ2=1.147,p=0.284).ConclusionHepatic artery angiographyand gadoxetic acid-enhanced MRIwere no significant differencefor the detection of small(≤2 cm)HCCs in patients.According to the different information of two techniques,selecting the optimal examination technique.At the same time of accurate staging,and may be relieve the pain of unnecessary examination. |
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