Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
AJR Am J Roentgenol. 2011 Jun;196(6):W758-65. doi: 10.2214/AJR.10.4394.
The purpose of this study was to determine the finding most predictive for characterizing hypervascular hepatocellular carcinoma (HCC) measuring 1 cm or less at gadoxetic acid-enhanced MRI that includes diffusion-weighted images.
In this retrospective study, between May 2008 and June 2009, 66 patients with 108 hypervascular HCCs 1 cm or smaller underwent gadoxetic acid-enhanced 3-T MRI that included diffusion-weighted images. The diagnosis of HCC was determined by surgical resection in 32 cases, percutaneous biopsy in three cases, or interval growth to larger than 1 cm on follow-up images in accordance with the American Association for the Study of Liver Diseases guidelines in 73 cases. MRI findings of HCC and 33 benign hypervascular lesions in a control group were analyzed by two radiologists in consensus. They based their assessments on the presence or absence of the following five findings: hyperintensity on T2-weighted images, hyperintensity on diffusion-weighted images with low b values, washout pattern, capsular enhancement, and hypointensity on gadoxetic acid-enhanced hepatobiliary phase images. The findings were compared by use of univariate and multivariate analyses.
No HCC with capsular enhancement was found. Fifty-seven HCCs (52.8%) had four findings, 36 (33.3%) had three, nine (8.3%) had two findings, and six (5.6%) had one finding. Univariate analysis showed significant differences between the HCC and control groups with respect to four findings (p < 0.0001). Multivariate analysis showed that hyperintensity on T2-weighted (p < 0.0001) and diffusion-weighted (p = 0.0081) images were statistically significant MRI findings for predicting HCC.
Hyperintensity on both T2- and diffusion-weighted images is helpful in the diagnosis of hypervascular HCC smaller than 1 cm in diameter.
本研究旨在确定在包括弥散加权成像在内的钆塞酸增强 MRI 上测量直径为 1cm 或更小的富血管性肝细胞癌（HCC）的特征性表现最具预测性的发现。
在这项回顾性研究中，2008 年 5 月至 2009 年 6 月，66 例 108 个直径 1cm 或更小的富血管性 HCC 患者接受了包括弥散加权成像在内的 3T 钆塞酸增强 MRI。通过手术切除确定 32 例 HCC 的诊断，通过经皮活检确定 3 例，根据美国肝病研究协会指南，在 73 例中通过随访图像上的间隔生长至大于 1cm 确定诊断。由两位放射科医生对 HCC 的 MRI 表现和对照组的 33 个良性富血管性病变进行了一致性分析。他们根据以下五种表现的存在或不存在进行评估：T2 加权图像上的高信号，低 b 值弥散加权图像上的高信号，洗脱模式，包膜增强和肝胆期图像上的低信号。通过单变量和多变量分析比较发现。
未发现具有包膜增强的 HCC。57 个 HCC（52.8％）有四个发现，36 个（33.3％）有三个发现，9 个（8.3％）有两个发现，6 个（5.6％）有一个发现。单变量分析显示 HCC 与对照组之间在四个发现方面存在显著差异（p <0.0001）。多变量分析显示，T2 加权（p <0.0001）和弥散加权（p = 0.0081）图像上的高信号是预测 HCC 的有统计学意义的 MRI 发现。
在直径小于 1cm 的富血管性 HCC 中，T2 和弥散加权图像上的高信号均有助于诊断。
