Maiwald Bettina, Lobsien Donald, Kahn Thomas, Stumpp Patrick
Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
PLoS One. 2014 Nov 6;9(11):e111935. doi: 10.1371/journal.pone.0111935. eCollection 2014.
To compare 64-slice contrast-enhanced computed tomography (CT) with 3-Tesla magnetic resonance imaging (MRI) using Gd-EOB-DTPA for the diagnosis of hepatocellular carcinoma (HCC) and evaluate the utility of diffusion-weighted imaging (DWI) in this setting.
3-phase-liver-CT was performed in fifty patients (42 male, 8 female) with suspected or proven HCC. The patients were subjected to a 3-Tesla-MRI-examination with Gd-EOB-DTPA and diffusion weighted imaging (DWI) at b-values of 0, 50 and 400 s/mm2. The apparent diffusion coefficient (ADC)-value was determined for each lesion detected in DWI. The histopathological report after resection or biopsy of a lesion served as the gold standard, and a surrogate of follow-up or complementary imaging techniques in combination with clinical and paraclinical parameters was used in unresected lesions. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated for each technique.
MRI detected slightly more lesions that were considered suspicious for HCC per patient compared to CT (2.7 versus 2.3, respectively). ADC-measurements in HCC showed notably heterogeneous values with a median of 1.2±0.5×10-3 mm2/s (range from 0.07±0.1 to 3.0±0.1×10-3 mm2/s). MRI showed similar diagnostic accuracy, sensitivity, and positive and negative predictive values compared to CT (AUC 0.837, sensitivity 92%, PPV 80% and NPV 90% for MRI vs. AUC 0.798, sensitivity 85%, PPV 79% and NPV 82% for CT; not significant). Specificity was 75% for both techniques.
Our study did not show a statistically significant difference in detection in detection of HCC between MRI and CT. Gd-EOB-DTPA-enhanced MRI tended to detect more lesions per patient compared to contrast-enhanced CT; therefore, we would recommend this modality as the first-choice imaging method for the detection of HCC and therapeutic decisions. However, contrast-enhanced CT was not inferior in our study, so that it can be a useful image modality for follow-up examinations.
比较64层对比增强计算机断层扫描（CT）与使用钆塞酸二钠（Gd-EOB-DTPA）的3特斯拉磁共振成像（MRI）对肝细胞癌（HCC）的诊断价值，并评估扩散加权成像（DWI）在此情况下的效用。
对50例疑似或确诊为HCC的患者（42例男性，8例女性）进行三期肝脏CT检查。患者接受3特斯拉MRI检查，使用Gd-EOB-DTPA并在b值为0、50和400 s/mm²时进行扩散加权成像（DWI）。测定DWI中检测到的每个病变的表观扩散系数（ADC）值。病变切除或活检后的组织病理学报告作为金标准，对于未切除的病变，采用随访或补充成像技术结合临床和辅助临床参数作为替代标准。评估每种技术的诊断准确性、敏感性、特异性以及阳性和阴性预测值。
与CT相比，MRI检测到每位患者中被认为可疑为HCC的病变略多（分别为2.7个和2.3个）。HCC中的ADC测量值显示出明显的异质性，中位数为1.2±0.5×10⁻³ mm²/s（范围为0.07±0.1至3.0±0.1×10⁻³ mm²/s）。与CT相比，MRI显示出相似的诊断准确性、敏感性以及阳性和阴性预测值（MRI的AUC为0.837，敏感性为92%，PPV为80%，NPV为90%；CT的AUC为0.798，敏感性为85%，PPV为79%，NPV为82%；差异无统计学意义）。两种技术的特异性均为75%。
我们的研究未显示MRI和CT在检测HCC方面存在统计学上的显著差异。与对比增强CT相比，Gd-EOB-DTPA增强MRI倾向于检测到每位患者更多的病变；因此，我们建议将这种检查方式作为检测HCC和做出治疗决策的首选成像方法。然而，在我们的研究中对比增强CT并不逊色，因此它可以作为随访检查的一种有用的成像方式。
