分析钆贝葡胺增强 MRI 检查在高危 HCC 患者中对 1-2cm 肝脏小结节的特征表现。
Analysis of gadobenate dimeglumine-enhanced MR findings for characterizing small (1-2-cm) hepatic nodules in patients at high risk for hepatocellular carcinoma.
机构信息
Department of Medical Imaging, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2.
出版信息
Radiology. 2011 Jun;259(3):730-8. doi: 10.1148/radiol.11101549. Epub 2011 Mar 1.
PURPOSE
To retrospectively identify magnetic resonance (MR) imaging findings that are associated with hepatocellular carcinoma (HCC) in 1-2-cm nodules detected at surveillance ultrasonography (US) and to propose newer MR imaging diagnostic criteria.
MATERIALS AND METHODS
Institutional research ethics board approval was obtained, and informed patient consent was waived. Among 145 consecutive patients who had 1-2-cm nodules that were newly detected at surveillance US, 108 patients underwent gadobenate dimeglumine-enhanced MR imaging. After excluding hemangiomas and unconfirmed nodules, the study sample comprised 96 patients with 116 nodules, including 43 HCCs and 73 benign nodules. MR imaging findings were assessed for signal intensity at each sequence. On the basis of the results of univariate and multivariable logistic regression analyses, several diagnostic criteria were developed by using combinations of MR imaging findings, which were then compared with the American Association for the Study of Liver Diseases (AASLD) practice guideline.
RESULTS
Univariate analysis revealed four imaging findings associated with HCC, including arterial phase hyperintensity, portal or delayed phase hypointensity (washout), hyperintensity on T2-weighted images, and hepatobiliary phase hypointensity (P < .001 for each). In the multivariable analysis, arterial phase hyperintensity (adjusted odds ratio [OR], 17.1; P = .003) and washout (adjusted OR, 11.7; P = .007) were associated with HCC. Of the developed criteria, the criteria including nodules fitting the AASLD practice guideline (arterial phase hyperintensity and washout) or nodules having three or more findings were considered most reasonable, showing improved sensitivity (77% [33 of 43] versus 67% [29 of 43], P = .048) and comparable specificity (95% [69 of 73] versus 99% [72 of 73], P = .09), as compared with AASLD practice guideline.
CONCLUSION
Alternative MR imaging criteria for diagnosing HCC in 1-2-cm nodules detected at surveillance US that can improve sensitivity compared with the AASLD practice guideline were proposed. A larger study is needed to verify the preliminary criteria in this study.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101549/-/DC1.
目的
回顾性分析在超声监测中新发现的 1-2cm 结节中与肝细胞癌（HCC）相关的磁共振成像（MR）表现，并提出新的 MR 成像诊断标准。
材料与方法
本研究获得了机构审查委员会的批准，并豁免了患者的知情同意。在 145 例连续接受超声监测新发现的 1-2cm 结节的患者中，108 例患者接受了钆贝葡胺增强 MR 成像检查。排除血管瘤和未确诊的结节后，研究样本包括 96 例患者的 116 个结节，其中 43 个为 HCC，73 个为良性结节。评估了每个序列的信号强度。基于单变量和多变量逻辑回归分析的结果，通过组合 MR 成像表现制定了几种诊断标准，然后将这些标准与美国肝病研究协会（AASLD）的实践指南进行了比较。
结果
单变量分析显示与 HCC 相关的四种影像学表现，包括动脉期高信号、门脉期或延迟期低信号（洗脱）、T2 加权图像高信号和肝胆期低信号（各表现 P＜0.001）。多变量分析显示动脉期高信号（校正比值比[OR]，17.1；P=0.003）和洗脱（校正 OR，11.7；P=0.007）与 HCC 相关。在制定的标准中，包括符合 AASLD 实践指南（动脉期高信号和洗脱）的结节或有三个或更多表现的结节的标准被认为最合理，其敏感性（77%[33/43]比 67%[29/43]，P=0.048）提高，特异性（95%[69/73]比 99%[72/73]，P=0.09）无显著差异。
结论
提出了一种替代的 MR 成像标准，用于诊断超声监测中新发现的 1-2cm 结节中的 HCC，与 AASLD 实践指南相比，该标准可以提高敏感性。需要更大的研究来验证本研究中的初步标准。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101549/-/DC1.
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