Costa Eduardo A C, Cunha Guilherme M, Smorodinsky Emmanuil, Cruite Irene, Tang An, Marks Robert M, Clark Lisa, Wolfson Tanya, Gamst Anthony, Sicklick Jason K, Hemming Alan, Peterson Michael R, Middleton Michael S, Sirlin Claude B
From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
Radiology. 2015 Sep;276(3):775-86. doi: 10.1148/radiol.2015142069. Epub 2015 Apr 15.
To determine per-lesion sensitivity and positive predictive value (PPV) of gadoxetic acid-enhanced 3-T magnetic resonance (MR) imaging for the diagnosis of malignant lesions by using matched (spatially correlated) hepatectomy pathologic findings as the reference standard. Materials and
In this prospective, institutional review board-approved, HIPAA-compliant study, 20 patients (nine men, 11 women; mean age, 59 years) with malignant liver lesions who gave written informed consent underwent preoperative gadoxetic acid-enhanced 3-T MR imaging for surgical planning. Two image sets were independently analyzed by three readers to detect liver lesions (set 1 without and set 2 with hepatobiliary phase [HBP] images). Hepatectomy specimen ex vivo MR imaging assisted in matching gadoxetic acid-enhanced 3-T MR imaging findings with pathologic findings. Interreader agreement was assessed by using the Cohen κ coefficient. Per-lesion sensitivity and PPV were calculated.
Cohen κ values were 0.64-0.76 and 0.57-0.84, and overall per-lesion sensitivity was 45% (42 of 94 lesions) to 56% (53 of 94 lesions) and 58% (55 of 94 lesions) to 64% (60 of 94 lesions) for sets 1 and 2, respectively. The addition of HBP imaging did not affect interreader agreement but significantly improved overall sensitivity for one reader (P < .05) and almost for another (P = .05). Sensitivity for 0.2-0.5-cm lesions was 0% (0 of 26 lesions) to 8% (two of 26 lesions) for set 1 and 4% (one of 26 lesions) to 12% (three of 26 lesions) for set 2. Sensitivity for 0.6-1.0-cm lesions was 28% (nine of 32 lesions) to 59% (19 of 32 lesions) for set 1 and 66% (21 of 32 lesions) to 69% (22 of 32 lesions) for set 2. Sensitivity for lesions at least 1.0 cm in diameter was at least 81% (13 of 16 lesions) for set 1 and was not improved for set 2. PPV was 98% (56 of 57 lesions) to 100% (60 of 60 lesions) for all readers without differences between image sets or lesion size.
Gadoxetic acid-enhanced 3-T MR imaging provides high per-lesion sensitivity and PPV for preoperative malignant liver lesion detection overall, although sensitivity for 0.2-0.5-cm malignant lesions is poor.
以匹配的（空间相关的）肝切除病理结果作为参考标准，确定钆塞酸二钠增强3T磁共振（MR）成像对恶性病变诊断的病灶敏感性和阳性预测值（PPV）。材料与方法：在这项经机构审查委员会批准、符合健康保险流通与责任法案（HIPAA）的前瞻性研究中，20例（9例男性，11例女性；平均年龄59岁）患有恶性肝病变且签署书面知情同意书的患者接受了术前钆塞酸二钠增强3T MR成像以用于手术规划。由三位阅片者独立分析两组图像以检测肝脏病变（第1组无肝胆期[HBP]图像，第2组有HBP图像）。肝切除标本的离体MR成像有助于将钆塞酸二钠增强3T MR成像结果与病理结果进行匹配。采用Cohen κ系数评估阅片者间的一致性。计算病灶敏感性和PPV。结果：Cohen κ值为0.64 - 0.76和0.57 - 0.84，第1组和第2组的总体病灶敏感性分别为45%（94个病灶中的42个）至56%（94个病灶中的53个）以及58%（94个病灶中的55个）至64%（94个病灶中的60个）。添加HBP成像不影响阅片者间的一致性，但对一位阅片者显著提高了总体敏感性（P <.05），对另一位阅片者几乎也有提高（P =.05）。第1组中，0.2 - 0.5cm病灶的敏感性为0%（26个病灶中的0个）至8%（26个病灶中的2个），第2组为4%（26个病灶中的1个）至12%（26个病灶中的3个）。第1组中，0.6 - 1.0cm病灶的敏感性为28%（32个病灶中的9个）至59%（32个病灶中的19个），第2组为66%（32个病灶中的21个）至69%（32个病灶中的22个）。第1组中，直径至少1.0cm病灶的敏感性至少为81%（16个病灶中的13个），第2组未改善。所有阅片者的PPV为98%（57个病灶中的56个）至100%（60个病灶中的60个），图像组或病灶大小之间无差异。结论：钆塞酸二钠增强3T MR成像总体上为术前恶性肝病变检测提供了较高的病灶敏感性和PPV，尽管对0.2 - 0.5cm恶性病变的敏感性较差。
