Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Gastroenterology. 2015 Jun;148(7):1371-82. doi: 10.1053/j.gastro.2015.02.051. Epub 2015 Feb 28.
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) has a high rate of intrahepatic recurrence after curative treatment, possibly because metastases are not always identified before treatment. Magnetic resonance (MR) imaging with a liver-specific contrast agent, gadoxetic acid, can detect small HCCs with high levels of sensitivity. We investigated whether MR imaging with gadoxetic acid increases overall and recurrence-free survival of patients initially assessed by computed tomography (CT).
We performed a retrospective study of data from 700 patients diagnosed with a single-nodular HCC by dynamic 4-phase CT in Seoul, Korea, from January 2009 through December 2010. Of these patients, 323 underwent additional evaluation with gadoxetic acid-enhanced MR imaging (CT+MR group). The 377 patients who did not undergo MR imaging analysis are referred to as the CT group.
The CT and CT+MR groups were comparable in most baseline characteristics (Child-Pugh class A, 93.1% vs 94.7%; and median size of the primary HCCs, 2.8 vs 2.6 cm, respectively). Seventy-four additional HCC nodules were detected in 53 (16.4%) of the patients who underwent MR evaluation after CT (CT+MR group). These detections increased the Barcelona Clinic Liver Cancer stages for 43 patients (13.3%) and modified their treatment plans. On multivariable analyses, the CT+MR group had a significantly lower rate of HCC recurrence (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.54-0.96) and lower overall mortality (HR, 0.65; 95% CI, 0.44-0.96) than the CT group. In an analysis of 285 pairs of patients matched on the basis of the propensity score, the CT+MR group had significantly lower overall mortality (HR, 0.66; 95% CI, 0.44-0.99).
Among patients who underwent dynamic CT analysis of a single-nodular HCC, additional evaluation by MR imaging with gadoxetic acid led to the detection of additional HCC nodules in 16% of patients, reduced the risk of disease recurrence, and decreased overall mortality.
肝癌（HCC）在根治性治疗后有很高的肝内复发率，这可能是因为在治疗前并非总能发现转移灶。钆塞酸增强磁共振成像（MRI）能以很高的灵敏度检测到具有高敏感性的小 HCC。我们研究了在最初通过计算机断层扫描（CT）评估的患者中，使用钆塞酸增强 MRI 是否会提高总体生存率和无复发生存率。
我们对 2009 年 1 月至 2010 年 12 月期间在韩国首尔通过动态 4 期 CT 诊断为单个结节 HCC 的 700 例患者的数据进行了回顾性研究。其中 323 例患者进行了额外的钆塞酸增强 MRI 检查（CT+MR 组）。377 例未进行 MRI 分析的患者被称为 CT 组。
CT 和 CT+MR 两组在大多数基线特征方面无差异（Child-Pugh 分级 A，93.1% vs 94.7%；原发性 HCC 的中位大小，2.8 cm vs 2.6 cm）。在 CT 后进行 MRI 评估的 53 例患者（16.4%）中，共检测到 74 个额外的 HCC 结节。这些发现使 43 例患者（13.3%）的巴塞罗那临床肝癌分期升高，并改变了他们的治疗计划。多变量分析显示，CT+MR 组 HCC 复发率显著降低（风险比[HR]，0.72；95%置信区间[CI]，0.54-0.96），总死亡率降低（HR，0.65；95%CI，0.44-0.96）。在基于倾向评分的 285 对患者匹配分析中，CT+MR 组的总死亡率显著降低（HR，0.66；95%CI，0.44-0.99）。
在接受单个结节 HCC 动态 CT 分析的患者中，通过钆塞酸增强 MRI 进行额外评估可使 16%的患者检测到更多 HCC 结节，降低疾病复发风险，降低总死亡率。
