Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan.
Radiology. 2011 Dec;261(3):834-44. doi: 10.1148/radiol.11101840. Epub 2011 Oct 13.
To describe imaging findings of early hepatocellular carcinoma (HCC) at gadoxetic acid-enhanced magnetic resonance (MR) imaging, dynamic contrast material-enhanced computed tomography (CT), CT during arterial portography (CTAP), and CT during hepatic arteriography (CTHA) and to compare the diagnostic performance of each modality for small (≤ 2 cm) HCC.
The institute ethics committee deemed study approval unnecessary. One hundred eight resected small lesions in 64 patients were diagnosed as a dysplastic nodule (DN) (n = 12), progressed HCC (n = 66), or early HCC (n = 30). All but two patients underwent all imaging examinations. The imaging characteristics of the lesions with each modality were determined. To evaluate the diagnostic performance of the modalities, two radiologists graded the presence of HCC with use of a five-point confidence scale. The area under the receiver operating characteristic curve (A(z)), sensitivity, and specificity of each modality were compared.
The imaging features that are statistically significant for differentiating an early HCC from a DN include fat-containing lesions at dual-echo T1-weighted MR imaging (seen in 16 of the 30 early HCCs and none of the DNs), low attenuation at unenhanced CT (seen in 13 of the 30 early HCCs and none of the DNs), low attenuation at CTAP (seen in 11 of the 30 early HCCs and none of the DNs), and low signal intensity at hepatocyte phase gadoxetic acid-enhanced MR imaging (seen in 29 of the 30 early HCCs and none of the DNs). The diagnostic performance of gadoxetic acid-enhanced MR imaging (A(z), 0.98 and 0.99) was significantly greater than that of contrast-enhanced CT (A(z), 0.87) and CTHA-CTAP (A(z), 0.85 and 0.86) owing to its significantly higher sensitivity (P < .001).
Gadoxetic acid-enhanced MR imaging is the most useful imaging technique for evaluating small HCC, including early HCC.
描述钆塞酸增强磁共振成像（MR）、动态对比增强 CT（CT）、动脉门静脉造影（CTAP）和肝动脉造影（CTHA）中早期肝细胞癌（HCC）的影像学表现，并比较各模态对小（≤2cm） HCC 的诊断性能。
机构伦理委员会认为本研究无需批准。对 64 例患者的 108 个切除的小病灶进行了研究，这些病灶被诊断为异型增生结节（DN）（n=12）、进展性 HCC（n=66）或早期 HCC（n=30）。除了两名患者之外，所有患者均进行了所有影像学检查。确定了各病灶的影像学特征。为了评估各模态的诊断性能，两位放射科医生使用五分制置信度量表对 HCC 的存在进行分级。比较了各模态的受试者工作特征曲线下面积（A(z)）、敏感度和特异度。
能够将早期 HCC 与 DN 区分开来的影像学特征包括：双回波 T1 加权 MR 成像上的含脂肪病变（在 30 个早期 HCC 中有 16 个，DN 中无）、平扫 CT 上的低衰减（在 30 个早期 HCC 中有 13 个，DN 中无）、CTAP 上的低衰减（在 30 个早期 HCC 中有 11 个，DN 中无）和肝细胞期钆塞酸增强 MR 成像上的低信号强度（在 30 个早期 HCC 中有 29 个，DN 中无）。由于其敏感度显著较高（P＜.001），钆塞酸增强 MR 成像（A(z)，0.98 和 0.99）的诊断性能明显优于增强 CT（A(z)，0.87）和 CTHA-CTAP（A(z)，0.85 和 0.86）。
钆塞酸增强 MR 成像对于评估小 HCC（包括早期 HCC）是最有用的影像学技术。
