Departments of Radiological Sciences, General Surgery, Division of Organ Transplantation, Surgery P. Valdoni, and Statistics, University of Rome Sapienza, Rome, Italy.
Radiology. 2010 Sep;256(3):806-16. doi: 10.1148/radiol.10091334.
To prospectively compare gadoxetate disodium-enhanced magnetic resonance (MR) imaging with multiphasic 64-section multidetector computed tomography (CT) in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis.
Institutional review board approval and informed patient consent were obtained for this prospective study. Fifty-eight patients (39 men, 19 women; mean age, 63 years; age range, 35-84 years) underwent gadoxetate disodium-enhanced MR imaging and multiphasic 64-section multidetector CT. The imaging examinations were performed within 30 days of each other. The two sets of images were qualitatively analyzed in random order by three independent readers in a blinded and retrospective fashion. Using strict diagnostic criteria for HCC, readers classified all detected lesions with use of a four-point confidence scale. The reference standard was a combination of pathologic proof, conclusive imaging findings, and substantial tumor growth at follow-up CT or MR imaging (range of follow-up, 90-370 days). The diagnostic accuracy, sensitivity, and positive predictive value were compared between the two image sets. Interreader variability was assessed. The accuracy of each imaging method was determined by using an adjusted modified chi(2) test.
Eighty-seven HCCs (mean size +/- standard deviation, 1.8 cm +/- 1.5; range, 0.3-7.0 cm) were confirmed in 42 of the 58 patients. Regardless of lesion size, the average diagnostic accuracy and sensitivity for all readers were significantly greater with gadoxetate disodium-enhanced MR imaging (average diagnostic accuracy: 0.88, 95% confidence interval [CI]: 0.80, 0.97; average sensitivity: 0.85, 95% CI: 0.74, 0.96) than with multidetector CT (average diagnostic accuracy: 0.74, 95% CI: 0.65, 0.82; average sensitivity: 0.69, 95% CI: 0.59, 0.79) (P < .001 for each). No significant difference in positive predictive value was observed between the two image sets for each reader. Interreader agreement was good to excellent.
Compared with multiphasic 64-section multidetector CT, gadoxetate disodium-enhanced MR imaging yields significantly higher diagnostic accuracy and sensitivity in the detection of HCC in patients with cirrhosis.
前瞻性比较钆塞酸二钠增强磁共振成像（MR）与多期 64 层多层螺旋 CT 在肝硬化患者肝细胞癌（HCC）检测中的作用。
本前瞻性研究获得了机构审查委员会的批准和患者的知情同意。58 例患者（39 名男性，19 名女性；平均年龄 63 岁；年龄范围 35-84 岁）接受了钆塞酸二钠增强 MR 成像和多期 64 层多层螺旋 CT 检查。这两种成像检查在 30 天内完成。三位独立的观察者以随机和盲法回顾的方式对两组图像进行定性分析。使用严格的 HCC 诊断标准，读者使用四点置信度评分对所有检测到的病变进行分类。参考标准是病理学证实、明确的影像学结果以及随访 CT 或 MR 成像（随访时间范围为 90-370 天）中肿瘤的实质性生长的综合。比较了两种图像集的诊断准确性、敏感度和阳性预测值。评估了读者间的变异性。使用调整后的改良卡方检验确定每种成像方法的准确性。
在 58 例患者中的 42 例中，确认了 87 个 HCC（平均大小 +/-标准差，1.8cm +/-1.5；范围，0.3-7.0cm）。无论病变大小如何，所有读者的钆塞酸二钠增强 MR 成像的平均诊断准确性和敏感度均显著高于多排螺旋 CT（平均诊断准确性：0.88，95%置信区间[CI]：0.80，0.97；平均敏感度：0.85，95% CI：0.74，0.96）（每个 P 值均<.001）。对于每个读者，两种图像集的阳性预测值之间没有显著差异。读者间的一致性为良好到极好。
与多期 64 层多层螺旋 CT 相比，钆塞酸二钠增强 MR 成像在肝硬化患者 HCC 的检测中具有更高的诊断准确性和敏感度。
