评估符合米兰标准的肝细胞癌患者：除肝脏CT外，肝脏钆塞酸二钠增强3.0 T磁共振成像是否必要？

Assessing patients with hepatocellular carcinoma meeting the Milan criteria: Is liver 3 tesla MR with gadoxetic acid necessary in addition to liver CT?

作者信息

Cha Dong Ik, Lee Min Woo, Kim Young Kon, Kim Seong Hyun, Park Hyun Jeong, Rhim Hyunchul, Lim Hyo K

机构信息

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, Republic of Korea.

出版信息

J Magn Reson Imaging. 2014 Apr;39(4):842-52. doi: 10.1002/jmri.24237. Epub 2013 Sep 30.

DOI:10.1002/jmri.24237

PMID:24115384

Abstract

PURPOSE

To determine the added value of 3 Tesla liver MR in patients with hepatocellular carcinoma (HCC) within the liver computed tomography (CT) -based Milan criteria.

MATERIALS AND METHODS

Liver CT and MR images of 130 patients with HCC within the Milan criteria based on liver CT were retrospectively reviewed. The number of MR-diagnosed HCCs and that of high risk hypervascular nodules (HRHNs), the effect of obtaining MR on patient management and CT appearances of MR-diagnosed HCCs and those of HRHNs were evaluated. Independent predictor for diagnosing additional HCCs on liver MR was analyzed.

RESULTS

A total of 18.5% (24/130) of patients had additional 39 HCCs on MR, with a 5.4% (7/130) dropout rate from the Milan criteria. 28.5% (37/130) of patients had additional 78 HRHNs. Overall, 39.2% (51/130) of patients required changes in management. The common CT appearances of MR-diagnosed HCCs were arterial enhancing lesions ≥ 0.5cm (38.4%, 15/39), low density nodules < 1.5 cm (30.8%, 12/39) and invisibility (28.2%, 11/39). For MR-diagnosed HRHNs, 55.1% (43/78) were invisible on CT. The presence of inconclusive lesions on CT was an independent predictor for diagnosing additional HCCs on MR.

CONCLUSION

For patients with HCCs within the Milan criteria on liver CT, liver MR may be necessary to detect additional HCCs and HRHNs.

摘要

目的

确定基于肝脏计算机断层扫描（CT）的米兰标准内肝细胞癌（HCC）患者中3特斯拉肝脏磁共振成像（MR）的附加价值。

材料与方法

回顾性分析130例基于肝脏CT符合米兰标准的HCC患者的肝脏CT和MR图像。评估MR诊断的HCC数量和高风险高血供结节（HRHN）数量、MR对患者治疗管理的影响以及MR诊断的HCC和HRHN的CT表现。分析肝脏MR上诊断额外HCC的独立预测因素。

结果

共有18.5%（24/130）的患者在MR上发现了另外39个HCC，米兰标准的剔除率为5.4%（7/130）。28.5%（37/130）的患者发现了另外78个HRHN。总体而言，39.2%（51/130）的患者需要改变治疗管理。MR诊断的HCC常见CT表现为动脉期强化病灶≥0.5cm（38.4%，15/39）、直径<1.5cm的低密度结节（30.8%，12/39）以及不可见（28.2%，11/39）。对于MR诊断的HRHN，55.1%（43/78）在CT上不可见。CT上存在不确定病变是MR诊断额外HCC的独立预测因素。