| Objective: Aims to clarify the value of disodium gadolinate enhanced magnetic resonance in the detection of focal liver lesions,and to explore the diagnostic model based on disodium gadolinated acid enhanced magnetic resonance transition phase and low signal in the hepatobiliary phase for hepatocellular carcinoma.Methods:A retrospective analysis was performed on 365 nodules in 221 patients who underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI for known or suspected focal lesions of the liver in the Affiliated Hospital of Guilin Medical College between January 2020 and April 2022.Two physicians independently assess the number,diameter,and location of liver nodules in two separate sessions.The hepatobiliary phase was not included in the first assessment and the hepatobiliary phase in the second assessment.The Kappa conformance test was used to analyze the concordance level of two physicians,and the paired chi-square test was used to compare the detection of liver nodules by two observation methods.Among the 365 nodules in 221 patients,178 liver nodules were selected to obtain pathological results or clinical follow-up diagnosis.Each nodule imaging sign was again independently evaluated by two physicians.Two diagnostic models were developed,the first model is "arterial phase non-annular hyper-strengthening + portal vein phase clearance(low signal)",and the second model is "arterial phase non-annular hyper-intensive + portal vein phase/transitional phase/hepatobiliary phase low signal".The diagnostic efficacy of the two diagnostic models for hepatocellular carcinoma was analyzed,expressed by sensitivity,specificity and accuracy,and the differences between the diagnostic models were evaluated by pairing chi-square test.Results:The two physicians had high agreement in both assessments,and the Kappa value of the consistency test was higher than 0.75.The detection rates of nodules in the first assessment of the two physicians were 86.03%(314/365)and 86.58%(316/365),and the detection rates of the nodules in the second assessment were 96.71%(353/365)and 97.53%(356/365),respectively.Therefore,the combination of gadolinated disodium to enhance the magnetic resonance hepatobiliary phase can improve the detection rate of focal liver lesions,P<0.05.In particular,in nodules ≤1 cm in diameter,the detection rate of the second evaluation increased by up to 30% compared to the first(55.17%vs.90.80%、57.47%vs.91.95%).In the diagnosis of hepatocellular carcinoma,the diagnostic sensitivity,specificity,accuracy and area under AUC of model I and model II were 74.42%(96/129),83.67%(41/49),76.97%(137/178),0.790(0.716-0.865)and 93.80%(121/129),69.39%(34/49),87.08%(155/178),0.816(0.734-0.898),respectively.The sensitivity and accuracy of model II was higher than that of model I,with a statistically significant difference of P < 0.05,and the difference was more significant when the nodule diameter was ≤3 cm.When the two models are re-evaluated together with DWI high signal,the diagnostic specificity of model II is significantly improved,and the diagnostic efficiency is further improved.Conclusions:Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhances magnetic resonance can improve the detection rate of focal liver lesions,especially lesions below 1 cm.In the diagnosis of hepatocellular carcinoma,especially small hepatocellular carcinoma,the diagnostic model "non-annular high reinforcement in the arterial phase + low signal in the portal venous phase/transitional phase/hepatobiliary phase" based on gadolinated disodium gadolinate enhanced magnetic resonance has higher diagnostic efficacy than the traditional diagnostic criteria. |
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