基于Gd-EOB-DTPA MRI对肝脏乏血供结节自然生长规律与病理基础的研究

A high incidence of primary hepatocellular carcinomas(HCCs) was reported in China worldwide. Most of the HCCs in China developed in patients with chronic Hepatitis B. Early diagnosis is important to the prognosis of HCCs. The application of dynamic imaging criteria based CT or MRI can be applied to patients with chronic hepatitis B. However, Dysplastic nodular and early HCC, the adjacent stages via a multiplestep process of carcinogenesis, have almost the same hemodynamic characteristics. So the sensitivity to the early HCC of the diagnostic criteria based on the extracellular fluid space contrast agent is not satisfied. Gd-EOB-DTPA is a new liver-specific hepatocellular agent for dual imaging, having the characteristics of an extracellular fluid space contrast agent during the early phases and a liver-specific hepatocellular agent during the hepatic phase. Along with its widespread use in patients with HBV, hypovascular hypointense nodules on hepatobiliary phase are increasingly detected. Will these nodules transform into the hypervascular hepatocelluar carcinoma? Is an active treatment needed? When and how? Fully understanding its natural growth law is of great significance to clinical treatment decisions. We’ll make the chronic HBV patients as our research object. Through a program of MRI follow-up, the rate of malignant transformation of these nodules will be obtained. Some factors which indicate malignant transformation will be found. And then to guide the clinical treatment timely.

中国是全球原发性肝细胞肝癌的高发地区，大部分肝癌发生于慢性乙型肝炎患者。早期诊断肝癌结节对于提高肝癌患者的预后有着重要的意义。对于慢性乙型肝炎患者，肝癌的诊断标准基于CT或MRI的多期动脉增强扫描，然而，异形增生结节和早期肝癌这两个肝癌多步态发展过程中的相邻阶段，血流动力学特点相似，因此基于细胞外对比剂的影像诊断标准对早期肝癌的诊断敏感性并不满意。钆塞酸二钠（Gd-EOB-DTPA）是一种新型肝细胞特异性造影剂，具有双相对比剂的特点，既有细胞外对比剂的特点，又有肝胆期肝细胞特异性对比剂的特点。随着近年来Gd-EOB-DTPA在慢性乙肝患者的广泛应用，MRI检出越来越多的乏血供肝胆期低信号结节，这些结节是否会转化为富血供肝癌结节？需不需要进行积极治疗？治疗时机和方式又如何选择？充分认识其自然生长规律，对提供临床治疗决策有重要意义。本项目以慢性乙肝病人为研究对象，通过有计划的MRI随诊观察来初步获得这些结节的恶性转化率，了解预示结节将会恶性转化的一些预测因素，从而指导临床给予及时给予处理。