胃肠道恶性肿瘤患者化疗诱导性局灶性肝病变：与临床病理相关性的钆塞酸增强及弥散加权 MR 成像。
Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: gadoxetic acid--enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation.
机构信息
From the Departments of Radiology (H.N.Y., B.J.P., D.J.S., M.J.K., S.B.C.), Surgery (D.S.K.), Internal Medicine (S.H.U.), and Pathology (N.H.W.), College of Medicine, and Department of Biostatistics (K.S.Y.), Korea University, Anam Hospital, 126-1 5-Ka, Anam-Dong, Sungbuk-ku, Seoul 136-705, Republic of Korea; Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (C.H.L.); Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea (Y.J.J.); and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea (S.Y.K.).
出版信息
Radiology. 2014 May;271(2):416-25. doi: 10.1148/radiol.13131810. Epub 2014 Jan 16.
PURPOSE
To retrospectively evaluate findings of chemotherapy-induced focal hepatopathy (CIFH) on gadoxetic acid-enhanced magnetic resonance (MR) and diffusion-weighted (DW) images and to determine imaging features that are most helpful in differentiating CIFH from metastasis.
MATERIALS AND METHODS
This retrospective study was approved by the institutional review board, and informed consent was waived. MR images, including DW images and gadoxetic acid-enhanced images, from 12 patients (four men, eight women; age range, 25-64 years) with 15 CIFHs were reviewed independently and in consensus by two radiologists and were compared with those obtained in 20 control patients (12 men, eight women; age range, 32-84 years) with 30 hepatic metastasis who were matched for tumor size, primary organ, and chemotherapy regimen. Interobserver agreement was assessed with κ statistics, and univariate analysis was performed for comparisons. For quantitative analyses, apparent diffusion coefficients (ADCs) and lesion-to-liver contrast ratios (CRs) were measured. Histopathologic examinations were performed for CIFHs.
RESULTS
Histopathologic examination revealed that the development of CIFHs was attributable to accentuated manifestations of sinusoidal obstruction syndrome. Interobserver agreement was excellent (κ > 0.85). An ill-defined margin on hepatobiliary phase (HBP) images was the most discriminating independent variable in the differentiation of CIFH from metastasis (odds ratio, 16; P = .009). ADC and CR values in CIFH group were significantly higher than those in metastasis group (P < .001 and P = .041).
CONCLUSION
CIFH should be considered a mimicker of metastasis in patients with gastrointestinal malignancy during chemotherapy. CIFH can be differentiated from metastasis on the basis of gadoxetic acid-enhanced MR and DW imaging findings; an ill-defined margin on HBP images was especially characteristic.
目的
回顾性分析钆塞酸增强磁共振（MR）和弥散加权（DW）图像中化疗诱导的局灶性肝病变（CIFH）的表现，并确定有助于区分 CIFH 与转移瘤的影像学特征。
材料与方法
本回顾性研究经机构审查委员会批准，豁免了知情同意。两名放射科医生独立和共识性地回顾了 12 例（4 名男性，8 名女性；年龄 25-64 岁）15 例 CIFH 患者的 MR 图像，包括 DW 图像和钆塞酸增强图像，并与 20 例（12 名男性，8 名女性；年龄 32-84 岁）30 例肝转移瘤患者进行了对比，这些患者在肿瘤大小、原发器官和化疗方案方面相匹配。采用 κ 统计评估观察者间的一致性，并进行单变量分析。对定量分析，测量表观扩散系数（ADC）和病变与肝脏对比比（CR）。对 CIFH 进行了组织病理学检查。
结果
组织病理学检查显示，CIFH 的发生归因于窦状隙阻塞综合征的明显表现。观察者间的一致性极好（κ>0.85）。肝胆期（HBP）图像上边界不清晰是区分 CIFH 与转移瘤的最具鉴别力的独立变量（优势比，16；P=.009）。CIFH 组的 ADC 和 CR 值明显高于转移瘤组（P<0.001 和 P=0.041）。
结论
在化疗期间患有胃肠道恶性肿瘤的患者中，CIFH 应被视为转移瘤的一种类似物。CIFH 可以基于钆塞酸增强 MR 和 DW 成像表现与转移瘤相区分；HBP 图像上边界不清晰是其特征性表现。
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