普美显诊断小肝癌临床应用 完整版

普美显诊断小肝癌临床应用1Gd-EOB-DTPAPrimovist®GadoxeticAcid

disoiumGd-EOB-DTPANNOOOOOOONGd3+

OOONa+ ONa+Chemical

structureDynamic

scanningExtracellular

Gd-DTPA50%totaldoseisabsorbedbyhepaticcell

and

Excretetobile

duct50%totaldoseisabsorbedbyhepaticcell

and

Excretetobile

ductDuo-functionalliver

specificMR

ContrastDuo-functionalliverspecificMR

Contrast1+1>2Gd-DTPAGd-EOB-DTPA2004Sweden2005

Europe2006

Japan2007

S.Korea2008

USA2011 China（2012-3

Shanghai）on

marketUptakeandexportmembrancetransportersinhuman

hepatocyteMechanismofHepatocytesuptakethe

Primovist90%HBP 10%APT2WIUptakingandexcretingissimilartothebilirubinmetabolism,whichisrelatedtransport

protein(glutathione

-S-transferase)OATP8uptakePrimovistwithsamerouteICG15，sowecouldassesstheliverfunctionusingthisspecificagent.HBP1、pre-contrast

GRE

T1WI

(inand

out

phase)

/

DWI

/MRCP2、pre-contrast

GRE

T1WI

withFSdynamiccontrastGRET1WIwith

FS（10mlprimovist+20mlH2Owith1.5-2ml/srate

injection）ClinicalProtocolof

ScanningExperiencefrommorethan

3000casesCareBolusTechniquefor

AP

--arterialphase（20s）Axial

Imaging--portalphase（60s）Axial

Imaging--equilibriumphaseordelayedphase(120s)Coronal/Axial

Imaging--transitionalphase(180s)Axial/CoronalImaging3、FSE

T2WI

with

FS+

Breath

Navigating4、Hepatobiliary

phase

GRE

T1WI

with

FS

(10-15min

)Totalbilirubin>1.2mg/dl(20-30min)---（serious

cirrhosis）5、Excretion

phase

of

Bileduct

CoronalGRE

T1WI

with

FS

（option）EOB-DTPAin

sHCCPre-contrastArterial

PhasePortal

PhaseT2WIDWIHBP1:勾勒病灶边缘和测量病灶大小更精准(HBP)。Micro-HCC(6mm)7T2WIGRE

T1APPVPHBP2、诊断微小肝癌（包括子灶和转移瘤）<1.0cm更有优势mHCC男，47岁肝癌介入术后五年，常规磁共振检查小复发灶显示不清preAPPPDPAPPPHBPTiny

FNHIt’sagreathelpfulwhensHCCisconfusedwithsFNHonconventionalMR

contrast12PMulti-FNHFNHOnHBP

ImagingHCCFNH16sHCCPseudo-enhancement3、异常灌注和微小肝癌的鉴别和确诊Shuntof

A－PShunt

of

A－P (regionalabnormalityofblood

perfusion）---“fake

enhancement”17Female,

46yoChronichepatitisB-inducedlivercirrhosisforover10yearsAFP

:231ng/mlTSE-T2WIUnenhanced3D

-VIBEAP+Gd-DTPA19APPVPPVPDPDPArterial

phaseGd-EOB-DTPAGd-DTPA20Portal

phaseDelayed

phase21Hepatobiliary

phaseHCCⅠ-Ⅱ级4、HCC分化程度的判断肝胆特异期：1 sHCC高信号（10-15%）2

分化好3

复发转移低4

预后好研究发现：基因突变OATP8（1B3）表达增高需进一步研究TwolesionsofHCCshowdifferentfeatureonHBPwithPrimovistatthesame

patient235、更准确理解肿瘤时空异质性男，57岁

结肠癌术后四年，口服异烟肼八年(脑膜结核）外院超声发现肝多发结节病灶（转移可能）T2W T1WI IAPPPDPHBP鉴别肝细胞增生性结节Patternofenhancementfor

sHCCGd-DTPA27Gd-EOB-DTPAAPPVPGRE

T1APPVPHBPGd-DTPAPatternofenhancementfor

sHCC28Gd-EOB-DTPAGRE

T1APPVPHBPAPPVPGd-DTPAPatternofenhancementfor

sHCC29Gd-EOB-DTPAPVPPVPAPAPGRE

T1HBPConclusion-Detection andCharacterizationofsmall

lesion(<1.0cm).30Comparedwithgadopentetatedimeglumine,gadoxeticacid-enhancedMRIdemonstratedadifferentenhancementpatternofinferiorarterialenhancement

andwasmorerapidlyhypointenseintheportalphasefor

HCC.Itshowedmarkedlylowerenhancementforhepatic

arteryandportalveininthepatientswith

cirrhosis.Strategyex.ofsHCCat

ZS-HospitalDopplerUS

+AFPHigh

riskpatients1\Hepatitis

B/C2\HBsAg(+)3\CirrhosisContrast

USImagingModalitiesbefore

2012200ng/ml(normal

<20ng/ml)TumormarkersC+MDCTMRspecific

contrastFollow

upDSA+Iodized

CTDSA+IodizedCT

314\family

HCC5\Addict

Alcohol6\NASHC+MRIPET/

CTDCP(inJapananS.Korea)Das_Gamma-CarboxyProthrombinFucosylatedfractionof

AFP(AFP-L3)Osteopontin(OPN)/Glypican-3(GPC-3)GP73/microRNAsPrimovistDUALPHASE

SCTT1T2Gd+MDCTvs.EOB-MRI（Primovist）52/F,rectalcancer,multiplelivermetastasesZhomgshan

Hospital NowFirstLineDoppler

US/AFPMoreHepatologistsandGeneral

Surgeons35Secondline：Conventional

DCE-MRIhighersensitivity&specificity，particularlymonitortheeffectsof

therapy

Recommended

PrimovistDiagnostic

Strategyof MRfor

sHCCinZhongshan

Hospital.Wash inWash

out- -+ -85-90%10-15%Diagnosis

sHCC+/-+ ++ -++ +Hypervascular

sHCCPrimovist

HBPHypovascular

sHCCLower

intensity5-10%5%

lesionsFollow

upBiopsyChinese Management

of

HCC

Guideline

based

Clinical

Practice（2016版）Recomm