From the Department of Radiology and Research Institute of Radiology (H.J.K., S.S.L., J.H.B., S.H.P., A.Y.K., H.K.H.) and Department of Surgery (J.C.K., C.S.Y.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songa-Gu, Seoul 138-736, Korea.
Radiology. 2015 Mar;274(3):712-22. doi: 10.1148/radiol.14140390. Epub 2014 Oct 3.
To prospectively compare diagnostic performance of diffusion-weighted (DW) imaging, gadoxetic acid-enhanced magnetic resonance (MR) imaging, both techniques combined (combined MR imaging), and computed tomography (CT) for detecting colorectal hepatic metastases and evaluate incremental value of MR for patients with potentially curable colorectal hepatic metastases detected with CT.
In this institutional review board-approved prospective study, with informed consent, 51 patients (39 men, 12 women; mean age, 62 years) with potentially resectable hepatic metastases detected with CT underwent liver MR, including DW imaging and gadoxetic acid-enhanced MR. Two independent readers reviewed DW, gadoxetic acid-enhanced, combined MR, and CT image sets to detect hepatic metastases. The figure-of-merit (FOM) value representing overall diagnostic performance, sensitivity, and positive predictive value (PPV) for each image set were analyzed by using free-response receiver operating characteristic analysis and generalized estimating equations.
There were 104 hepatic metastases in 47 patients. The pooled FOM values, sensitivities, and PPVs of combined MR (FOM value, 0.93; sensitivity, 98%; and PPV, 88%) and gadoxetic acid-enhanced MR (FOM value, 0.92; sensitivity, 95%; and PPV, 90%) were significantly higher than those of CT (FOM value, 0.82; sensitivity, 85%; and PPV, 73%) (P < .006). The pooled FOM value and sensitivity of combined MR (FOM value, 0.92; sensitivity, 95%) was also significantly higher than that of DW imaging (FOM value, 0.82; sensitivity, 79%) for metastases (≤1-cm diameter) (P ≤ .003). DW imaging showed significantly higher pooled sensitivity (79%) and PPV (60%) than CT (sensitivity, 50%; PPV, 33%) for the metastases (≤1-cm diameter) (P ≤ .004). In 47 patients with hepatic metastases, combined MR depicted more metastases than CT in 10 and 14 patients, respectively, according to both readers.
Gadoxetic acid-enhanced MR and combined MR are more accurate than CT in detecting colorectal hepatic metastases, have an incremental value when added to CT alone for detecting additional metastases, and can be routinely performed in patients with potentially curable hepatic metastases detected with CT.
前瞻性比较扩散加权（DW）成像、钆塞酸增强磁共振（MR）成像、两种技术联合（联合 MR 成像）以及计算机断层扫描（CT）在检测结直肠癌肝转移中的诊断性能，并评估钆塞酸增强 MR 对 CT 检测到的具有潜在可切除性结直肠癌肝转移患者的附加价值。
本研究经机构审查委员会批准，并获得患者知情同意，51 例（39 例男性，12 例女性；平均年龄，62 岁）患者因 CT 检测到具有潜在可切除性肝转移而行肝脏 MR 检查，包括 DW 成像和钆塞酸增强 MR。两名独立的读者分别对 DW、钆塞酸增强、联合 MR 和 CT 图像进行评估，以检测肝转移。采用自由反应接收器操作特性分析和广义估计方程分析每个图像组的整体诊断性能、灵敏度和阳性预测值（PPV）的特征值（FOM）值。
47 例患者中共有 104 个肝转移灶。联合 MR（FOM 值 0.93，灵敏度 98%，PPV 88%）和钆塞酸增强 MR（FOM 值 0.92，灵敏度 95%，PPV 90%）的 FOM 值、灵敏度和 PPV 均显著高于 CT（FOM 值 0.82，灵敏度 85%，PPV 73%）（P<.006）。联合 MR 的 FOM 值和灵敏度（FOM 值 0.92，灵敏度 95%）也显著高于 DW 成像（FOM 值 0.82，灵敏度 79%），用于检测（≤1cm 直径）的转移灶（P≤.003）。DW 成像对（≤1cm 直径）转移灶的灵敏度（79%）和 PPV（60%）均显著高于 CT（灵敏度 50%，PPV 33%）（P≤.004）。在 47 例肝转移患者中，根据两位读者的评估，联合 MR 分别比 CT 多发现 10 例和 14 例转移灶。
与 CT 相比，钆塞酸增强 MR 和联合 MR 能更准确地检测结直肠癌肝转移，单独使用 CT 检测到转移灶时，联合使用能增加诊断准确性，还可常规用于 CT 检测到的具有潜在可切除性肝转移患者。
