Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Ann Surg Oncol. 2013 Sep;20(9):2893-900. doi: 10.1245/s10434-013-3001-y. Epub 2013 May 7.
We assessed the change in the therapeutic decision among curative treatments after adding Gd-EOB-DTPA-enhanced MRI to triple-phase MDCT for patients with early-stage HCC.
This study retrospectively investigated two groups: 33 pathologically confirmed HCC patients after liver transplantation in group 1; 34 HCC patients without pathology in group 2. In group 1, we simulated the therapeutic decision-making process by pretransplant MDCT and Gd-EOB-DTPA-enhanced MRI. In group 2, including the 34 early-stage HCC patients consecutively enrolled, we investigated the change of therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT.
In the simulation from group 1, after adding Gd-EOB-DTPA-enhanced MRI, 33.3% (11/33 patients) of treatment decisions were changed from the decision based on MDCT alone. Among 22 patients considered eligible for resection and 33 patients for radiofrequency ablation, the therapeutic decision was changed for 10 patients in the surgical group and 4 patients for the RFA group (45.5 and 12.1%). In group 2, the rate of change in the therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT was 41.2% (14/34 patients). In group 1 with explants pathology, the median diameter of HCCs not detected by MDCT but detected by Gd-EOB-DTPA-enhanced MRI was 1.15 cm (0.3-3.0 cm). The median diameter of HCCs seen only in the explanted liver was 1.0 cm (0.3-1.7 cm), and 60.7% of them were well-differentiated HCCs.
This study suggests that performing Gd-EOB-DTPA-enhanced MRI before deciding on curative treatment for early-stage HCC may improve the accuracy of treatment decision for early-stage HCC.
我们评估了在三阶段 MDCT 中加入钆塞酸二钠增强 MRI 后，对早期 HCC 患者进行根治性治疗的治疗决策变化。
本研究回顾性调查了两组患者：第 1 组为 33 例经肝移植术后病理证实的 HCC 患者；第 2 组为 34 例无病理 HCC 患者。在第 1 组中，我们通过移植前 MDCT 和 Gd-EOB-DTPA 增强 MRI 模拟治疗决策过程。在第 2 组中，包括连续纳入的 34 例早期 HCC 患者，我们研究了在 MDCT 中加入 Gd-EOB-DTPA 增强 MRI 后治疗决策的变化。
在第 1 组的模拟中，在加入 Gd-EOB-DTPA 增强 MRI 后，33.3%（33 例患者中的 11 例）的治疗决策从单纯基于 MDCT 的决策改变。在 22 例被认为适合手术切除和 33 例适合射频消融的患者中，手术组中有 10 例和 RFA 组中有 4 例（45.5%和 12.1%）的治疗决策发生改变。在第 2 组中，在 MDCT 中加入 Gd-EOB-DTPA 增强 MRI 后，治疗决策改变的比例为 41.2%（34 例患者中的 14 例）。在有肝移植标本病理的第 1 组中，MDCT 未检出但 Gd-EOB-DTPA 增强 MRI 检出的 HCC 的中位直径为 1.15cm（0.3-3.0cm）。仅在肝移植标本中可见的 HCC 的中位直径为 1.0cm（0.3-1.7cm），其中 60.7%为高分化 HCC。
本研究表明，在决定早期 HCC 的根治性治疗前进行 Gd-EOB-DTPA 增强 MRI 可能会提高早期 HCC 治疗决策的准确性。
