Radiology Unit, Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Eur Radiol. 2011 Jun;21(6):1233-42. doi: 10.1007/s00330-010-2030-1. Epub 2011 Feb 5.
To prospectively assess the additional value of the hepatobiliary (HB) phase of Gd-EOB-DTPA-MRI in identifying and characterising small (≤ 2 cm) hepatocellular carcinomas (HCCs) undetermined in dynamic phases alone because of their atypical features, according to the AASLD criteria.
127 cirrhotic patients were evaluated with Gd-EOB-DTPA-MRI in two sets: unenhanced and dynamic phases; unenhanced, dynamic and HB phases. Sixty-two out of 215 nodules (29%) were atypical in 42 patients (33%).
62 atypical nodules were reported at histology: high-grade dysplastic nodules (HGDN)/early HCC (n = 20), low-grade DN (LGDN) (n = 21), regenerative nodules (n = 17) and nodular regenerative hyperplasia (n = 4). The sensitivity, specificity, accuracy, positive and negative predictive value (PPV, NPV) were increased by the addition of the HB phase: 88.4-99.4%, 88-95%, 88-98.5%, 97-99%, and 65-97.5%, respectively. Twenty atypical nodules were malignant (32%), 19 of which were characterised only during the HB phase.
The HB phase is 11% more sensitive in the classification of HGDN/early HCC than dynamic MRI, with an added value of 32.5% in the NPV. The high incidence (33%) of atypical nodules and their frequent malignancy (32%) suggest the widespread employment of Gd-EOB-DTPA-MRI in the follow-up of small nodules (≤ 2 cm) in cirrhosis.
前瞻性评估钆塞酸二钠增强 MRI 肝胆期（HB 期）在识别和特征描述小（≤ 2cm）肝细胞癌（HCC）中的额外价值，这些 HCC 因不典型特征而在单独使用动态期时无法确定，其依据是 AASLD 标准。
127 例肝硬化患者分别接受了 Gd-EOB-DTPA-MRI 的两组检查：平扫和动态期；平扫、动态期和 HB 期。42 例患者的 215 个结节中（33%）有 62 个（29%）不典型。
62 个不典型结节在组织学上报告为：高级别异型增生结节（HGDN）/早期 HCC（n=20）、低级别异型增生结节（LGDN）（n=21）、再生结节（n=17）和结节性再生性增生（n=4）。增加 HB 期后，灵敏度、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别提高到 88.4-99.4%、88-95%、88-98.5%、97-99%和 65-97.5%。20 个不典型结节为恶性（32%），其中 19 个仅在 HB 期被特征化。
与动态 MRI 相比，HB 期在 HGDN/早期 HCC 的分类中提高了 11%的灵敏度，NPV 的附加价值为 32.5%。不典型结节的高发率（33%）及其频繁的恶性程度（32%）表明，在肝硬化患者小（≤ 2cm）结节的随访中，广泛使用 Gd-EOB-DTPA-MRI。
