Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Radiology. 2012 Sep;264(3):761-70. doi: 10.1148/radiol.12112517. Epub 2012 Jul 27.
To determine if the combination of gadoxetic acid-enhanced magnetic resonance (MR) imaging and diffusion-weighted (DW) imaging helps to increase accuracy and sensitivity in the diagnosis of small hepatocellular carcinomas (HCCs) compared with those achieved by using each MR imaging technique alone.
The institutional review board approved this retrospective study and waived the requirement for informed consent. The study included 130 patients (95 men, 35 women) with 179 surgically confirmed small HCCs (≤2.0 cm) and 130 patients with cirrhosis (90 men, 40 women) without HCC who underwent gadoxetic acid-enhanced MR imaging and DW imaging at 3.0 T between May 2009 and July 2010. Three sets of images were analyzed independently by three observers to detect HCC: a gadoxetic acid set (unenhanced, early dynamic, and hepatobiliary phases), a DW imaging set, and a combined set. Data were analyzed by using alternative-free response receiver operating characteristic analysis. Diagnostic accuracy (area under the receiver operating characteristic curve [A(z)]), sensitivity, specificity, and positive predictive value were calculated.
The mean A(z) values for the combined set (0.952) were significantly higher than those for the gadoxetic acid set (A(z) = 0.902) or the DW imaging set alone (A(z) = 0.871) (P ≤ .008). On a per-lesion basis, observers showed higher sensitivity in their analyses of the combined set (range, 91.1%-93.3% [163-167 of 179]) than in those of the gadoxetic acid set (range, 80.5%-82.1% [144-147 of 179]) or the DW imaging set alone (range, 77.7%-79.9% [139-143 of 179]) (P ≤ .003). Positive predictive values and specificity for all observers were equivalent for the three imaging sets.
The combination of gadoxetic acid-enhanced MR imaging and DW imaging yielded better diagnostic accuracy and sensitivity in the detection of small HCCs than each MR imaging technique alone.
确定与单独使用磁共振成像（MR）技术相比，钆塞酸增强磁共振成像（MR）和弥散加权（DW）成像的联合应用是否有助于提高小肝细胞癌（HCC）诊断的准确性和敏感性。
本回顾性研究经机构审查委员会批准，并豁免了知情同意书的要求。该研究纳入了 2009 年 5 月至 2010 年 7 月在 3.0T 磁共振扫描仪上接受钆塞酸增强 MR 成像和 DW 成像检查的 130 例（男 95 例，女 35 例）经手术证实的小 HCC（≤2.0cm）患者和 130 例（男 90 例，女 40 例）无 HCC 的肝硬化患者。三位观察者独立分析了三组图像以检测 HCC：一组为钆塞酸增强图像（平扫、早期动态和肝胆期）、一组为 DW 成像图像，还有一组为联合图像。使用无替代的受试者工作特征分析（ROC）分析数据。计算诊断准确性（ROC 曲线下面积[A（z）]）、敏感性、特异性和阳性预测值。
联合组的平均 A（z）值（0.952）明显高于钆塞酸组（A（z）=0.902）或 DW 成像组单独组（A（z）=0.871）（P≤0.008）。基于每例病变，观察者在联合组的分析中显示出更高的敏感性（范围为 91.1%-93.3%[163-167/179]），高于钆塞酸组（范围为 80.5%-82.1%[144-147/179]）或 DW 成像组单独组（范围为 77.7%-79.9%[139-143/179]）（P≤0.003）。所有观察者的阳性预测值和特异性在三种成像组之间均相当。
与单独使用 MR 成像技术相比，钆塞酸增强 MR 成像和 DW 成像的联合应用可提高小 HCC 的诊断准确性和敏感性。
