肝硬化肝脏中的肝细胞癌：双对比增强、高分辨率3.0T磁共振成像与病理对照

Hepatocellular carcinoma in cirrhotic liver: double-contrast-enhanced, high-resolution 3.0T-MR imaging with pathologic correlation.

作者信息

Yoo Hye Jin, Lee Jeong Min, Lee Min Woo, Kim Soo Jin, Lee Jae Young, Han Joon Koo, Choi Byung Ihn

机构信息

Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Chongno-Gu, Seoul, Korea.

出版信息

Invest Radiol. 2008 Jul;43(7):538-46. doi: 10.1097/RLI.0b013e3181768d96.

DOI:10.1097/RLI.0b013e3181768d96

PMID:18580337

Abstract

OBJECTIVES

To determine the diagnostic performance of double-contrast-enhanced (DCE) magnetic resonance imaging (MRI) at 3.0T in the detection of hepatocellular carcinoma (HCC) in patients with a cirrhotic liver.

MATERIALS AND METHODS

This study was approved by our Institutional Review Board and did not require informed consent. A total of 61 patients (52 men, 9 women; range 27-83 years) underwent DCE-MRI at 3.0T. DCE-MRI was composed of baseline MR images, superparamagnetic iron oxide-enhanced T2- and T2*-weighted images, and gadobenate-dimeglumine-enhanced dynamic MR images. The diagnosis of HCC was established at transplantation (n = 12) and hepatic resection (n = 49). Three observers independently analyzed each image in random order. The diagnostic performance, sensitivity, positive predictive value, numbers and causes of false positive and negative findings, and interobserver variability were calculated and analyzed on a per-lesion basis.

RESULTS

: Sixty-one patients had 95 HCCs. From alternative free-response receiver operating characteristic analysis, averaged diagnostic performance (Az) was 0.90. The mean sensitivity and positive predictive value of DCE-MRI at 3.0T for detection of HCCs were 89% and 97%, respectively. There was a significant difference in the sensitivity for the detection of HCCs between Child-Pugh class A and C patients (97% and 63%, respectively) (P < 0.01). In addition, the sensitivity according to lesion size was significantly different (P < 0.01). There were 7 false-positive lesions [arterio-portal shunt (n = 1), dysplastic nodule (n = 1), hemangioma (n = 2), and partial volume averaging (n = 3)]. Thirteen false-negatives occurred mainly because of small size (n = 4), partial uptake of superparamagnetic iron oxide (n = 6), faint arterial enhancement (n = 7), and location (n = 2). There was good interobserver variability (kappa: 0.622-0.670).

CONCLUSIONS

DCE 3.0T MR imaging is a highly sensitive modality for diagnosing HCCs in patients with a cirrhotic liver.

摘要

目的

确定3.0T双对比增强（DCE）磁共振成像（MRI）对肝硬化患者肝细胞癌（HCC）的诊断效能。

材料与方法

本研究经机构审查委员会批准，无需知情同意。共有61例患者（52例男性，9例女性；年龄范围27 - 83岁）接受了3.0T的DCE-MRI检查。DCE-MRI包括基线MR图像、超顺磁性氧化铁增强的T2加权和T2*加权图像以及钆贝葡胺增强的动态MR图像。HCC的诊断通过移植（n = 12）和肝切除（n = 49）确定。三位观察者以随机顺序独立分析每张图像。基于每个病灶计算并分析诊断效能、敏感性、阳性预测值、假阳性和假阴性结果的数量及原因以及观察者间的变异性。

结果

61例患者中有95个HCC病灶。通过替代自由反应接收器操作特征分析，平均诊断效能（Az）为0.90。3.0T的DCE-MRI检测HCC的平均敏感性和阳性预测值分别为89%和97%。Child-Pugh A级和C级患者检测HCC的敏感性存在显著差异（分别为97%和63%）（P < 0.01）。此外，根据病灶大小的敏感性也存在显著差异（P < 0.01）。有7个假阳性病灶[动门脉分流（n = 1）、发育异常结节（n = 1）、血管瘤（n = 2）和部分容积平均效应（n = 3）]。13例假阴性主要是由于病灶小（n = 4）、超顺磁性氧化铁部分摄取（n = 6）、动脉期强化不明显（n = 7）和位置因素（n = 2）。观察者间变异性良好（kappa：0.622 - 0.670）。