Influencing Factors Of Respiratory Artifacts During GD-EOB-DTPA-Enhanced MRI Arterial Phase In Patients With Hepatocellular Carcinoma And The Diagnostic Value For Hepatocellular Carcinoma

Part one Influencing Factors of Respiratory Artifacts during Gd-EOB-DTPA-Enhanced MRI Arterial Phase in Patients with Hepatocellular CarcinomaObjective:To explore the factors that influence the arterial phase respiratory artifacts in patients with Hepatocellular Carcinoma（HCC）when using Gd-EOB-DTPA-enhanced MRI.Methods:Patients who underwent GD-EOB-DTPA and GD-DTPA enhanced MRI were collected retrospectively and matched 1:1 according to age±2 years,gender,and BMI±2kg/m².123 patients with Hepatocellular Carcinoma were included in both groups.The equipment used was GE STGNA HDE1.5T MRI.Patients were grouped according to the presence or absence of liver cirrhosis,history of allergy and TACE treatment,Child-Pugh classification of liver function,tumor size,presence or absence of pleural effusion,and abdominal effusion.Arterial phase images of 246 patients were scored by two physicians,and the severity of respiratory artifacts was rated as1-5 points.Kruskal-Wallis rank sum test and Wilcoxon rank sum test were used to analyze the differences between each influencing factor and arterial respiratory artifacts,and whether the use of different contrast agents in the two groups had an effect on arterial artifacts.A score of≥4 was defined as moderate-severe respiratory artifact（TSM）,which was divided into two groups with and without TSM,and the factors with P value<0.2 in the analysis of variance are selected for binary logistic regression to test the correlation between each index and the artifact of arterial phase.Results:According to the results of the difference analysis,the P value of patient’s age,gender,presence of cirrhosis and peritoneal effusion,size of cancer about the respiratory artifacts during arterial phase were all>.0.2,the difference was not statistically significant;the factors of P value<0.2 include whether or not there is history of allergies,TACE treatment,pleural effusion,Child-Pugh classification of liver function,and types of contrast agents.The patients were divided into two groups(according to the arterial phase image score,one group’s score<4（n=220）and another group’s score≥4（n=26）.The binary Logistics regression showed these factors’s P value>0.05,including whether there was a history of allergies and the history of TACE treatment that indicated no statistical significance.The P value of Child-Pugh classification of liver function,presence or absence of pleural effusion and The P value of different contrast media on the arterial phase image score is<0.05,and the difference is statistically significant,indicating that the three are related to the occurrence of TSM in the arterial phase.Part two Compare the Diagnostic Efficiency between Gd-EOB-DTPA and Gd-DTPA-Enhanced MRI by Using LI-RADS to Diagnose Liver Cancer in Patients with High Risk of Hepatocellular CarcinomaObjective:When using LI-RADS to diagnose HCC,compare the diagnostic efficacy of Gd-EOB-DTPA and Gd-DTPA enhanced MRI in patients with high risk of Hepatocellular carcinoma,and determine whether the Gd-EOB-DTPA enhanced hepatobiliary phase has a compensating effect.Methods:Patients with cirrhosis and liver occupying lesions who underwent GD-EOB-DTPA or GD-DTPA enhancement were retrospectively collected.A 1:1 match was performed according to age±2 years,gender and lesion size±1cm（minimum tumor diameter was 1cm）.Eighty-seven patients in both groups were enrolled.The equipment used was GE 1.5T MRI.Two physicians classified the enhanced images of Gd-EOB-DTPA three and four phases and Gd-DTPA three phases according to the LI-RADS standard,and diagnosed the cases of LR-4 and 5 as HCC.Calculate the sensitivity,specificity and accuracy of the three groups.And compare the changes of LI-RADS grade after adding hepatobiliary stage.Results:There were 97 lesions in the Gd-EOB-DTPA group and 103lesions in the Gd-DTPA group.There were 81 and 76 HCC lesions in the two groups,and 16 and 27 non-HCC lesions,respectively.Compared with the Gd-DTPA three-phase enhanced scan,the sensitivity,specificity and accuracy of the Gd-EOB-DTPA four-phase enhanced scan are improved（81.55%vs92.78%）,and the difference is statistically significant,that is,the diagnostic efficiency of Gd-EOB-DTPAis Higher.The diagnostic accuracy of Gd-DTPA and Gd-EOB-DTPA three-phase enhanced scan is not statistically significant（81.55%vs 80.41%）,and the three-phase enhanced diagnostic efficiency of the two is basically the same;in addition,compared with the third stage,the diagnostic efficiency of Gd-EOB-DTPA four-phase enhanced scan is higher（80.41%vs 92.78%）,and the difference is statistically significant,indicating that due to the existence of the hepatobiliary stage,the diagnostic efficiency of Gd-EOB-DTPA is higher than that of Gd-DTPA.After increasing the hepatobiliary phase,16.0%（13/81）of lesions’LI-RADS grade was changed,and the diagnosis of nine lesions was corrected.Part three Using the Signal Intensity of Gd-EOB-DTPA-Enhanced MRI Imaging of Hepatobiliary Phase to Identify Liver Focal LesionsObjective:To study whether the signal intensity（SI）of Gd-EOB-DTPA Enhanced MRI Imaging of Hepatobiliary Phase can provide a basis for the differential diagnosis of focal liver lesions.Methods:A total of 245 patients who received Gd-EOB-DTPA liver enhancement examination were included in this project,including 92untreated and histopathologically confirmed HCC cases,with typical imaging findings or histopathologically confirmed 97 cases of hemangioma and 56cases of metastatic tumors.The equipment used is GE 1.5T MRI.Two physicians set ROI on GD-EOB-DTPA enhanced MRI hepatobiliary phase images,and measured the signal intensity（SI）of the lesion on T1WI phase and hepatobiliary phase image,respectively,and calculated the enhancement rate of the lesion,CER=SI_hbp-SI_pre/SI_pre.One-way ANOVA was used to compare the CER of the three lesions by Scheffe method,P<0.05 indicates that the differences are statistically significant.Plot the ROC curve,and get the Cut-off value to distinguish the three types of lesions.Results:The hepatobiliary CER of the HCC group（0.543±0.300）was lower than that of the hemangioma group（0.780±0.378）,and the difference was statistically significant（P=0.001）.The hepatobiliary CER（0.543±0.35）of the HCC group was lower than that of the metastasis group（0.597±0.312）,and the difference was not statistically significant（P=0.332）.The hepatobiliary enhancement rate CER（0.597±0.312）of the metastatic tumor group was lower than the hepatobiliary CER（0.780±0.378）of the hemangioma group,and the difference was statistically significant（P=0.036）.After drawing the ROC curve,it is concluded that when the CER value is greater than 0.434,it is considered as a hemangioma,when it is less than that,it is considered as a metastasis;when the CER value is greater than 0.475,it is considered as a hemangioma,and when it is less than that,it is considered as HCC.and there was still no difference between HCC and metastatic tumor.Conclusion:1.Gd-EOB-DTPA had a higher incidence of respiratory artifacts than Gd-DTPA in the arterial phase.In addition,there was no correlation between age,gender,cirrhosis,history of allergy,abdominal effusion and size of cancer focus and occurrence of respiratory artifacts.Child-Pugh grade of liver function,presence of pleural effusion,and side effect of Gd-EOB-DTPA contrast agent itself might be the causes of respiratory artifacts induced in arterial phase.2.Due to the compensation effect of hepatobiliary phase,Gd-EOB-DTPA-enhanced MRI has improved diagnostic accuracy,sensitivity and specificity,when compared with Gd-DTPA-enhanced MRI.Gd-EOB-DTPA-enhanced MRI can improve the accuracy of LI-RADS classification,and the combination of the two can be closer to accurate diagnosis.3.The signal enhancement rate（CER）of hepatic hemangioma in hepatobiliary phase was different from that of HCC and metastatic tumors,but there was no significant difference between the CER of HCC and metastatic tumors.These results indicate that CER has certain value in the differential diagnosis of hepatic hemangioma,HCC and metastatic tumor,but more data are still needed for more in-depth research.