Cortis Kelvin, Liotta Rosa, Miraglia Roberto, Caruso Settimo, Tuzzolino Fabio, Luca Angelo
Diagnostic and Therapeutic Services Department Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Palermo, Italy
Diagnostic and Therapeutic Services Department Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Palermo, Italy.
Acta Radiol. 2016 Aug;57(8):923-31. doi: 10.1177/0284185115616291. Epub 2015 Nov 13.
Diagnosis of hepatocellular carcinoma (HCC) is centered on wash-in of contrast during the arterial phase followed by washout during the portal or delayed venous phase. Nodules showing hypointensity on the hepatobiliary phase are also likely to represent HCC, however, the role of this phase is not yet established.
To investigate the role of the hepatobiliary phase on Gadobenate dimeglumine (Gd-BOPTA) magnetic resonance imaging (MRI) in characterizing HCCs lacking the typical arterial enhancement and venous washout.
Ninety-seven cirrhotic patients (78 men, 19 women; mean age, 58.5 years) who underwent liver transplantation (2004-2012) and Gd-BOPTA enhanced MRI within 3 months of surgery were retrospectively reviewed. A nodule-by-nodule analysis was performed, followed by liver explant correlation. Statistical analysis was then performed by a biostatistician using commercially available software.
A total of 193 HCCs were found in 97 liver explants, of which 24.9% (48/193) were not detectable on imaging. The 145 HCCs seen on imaging showed the typical wash-in/washout pattern (Pattern A) in 46.9% (68/145), arterial enhancement without washout (Pattern B) in 37.9% (55/145), and hypovascularity on arterial and venous sequences (Pattern C) in 15.2% (22/145). Pattern A was exclusive to HCC. Twenty-three of the 55 HCCs showing Pattern B were also hypointense on the hepatobiliary phase (Pattern B1). Combining Pattern B1 with Pattern A raises the sensitivity of HCC characterization from 46.9% to 62.8% (P = 0.007), with no significant compromise on specificity.
When coupled with Pattern A, Pattern B1 augments sensitivity of HCC characterization with no significant compromise on the specificity.
肝细胞癌（HCC）的诊断主要基于动脉期对比剂的快速注入以及随后门静脉期或延迟静脉期的廓清。在肝胆期表现为低信号的结节也可能是HCC，但该期的作用尚未明确。
探讨钆贝葡胺（Gd - BOPTA）磁共振成像（MRI）的肝胆期在鉴别缺乏典型动脉期强化和静脉期廓清的HCC中的作用。
回顾性分析97例肝硬化患者（78例男性，19例女性；平均年龄58.5岁），这些患者在2004年至2012年期间接受了肝移植，并在术后3个月内进行了Gd - BOPTA增强MRI检查。对每个结节进行分析，随后与肝移植切除标本进行对照。然后由生物统计学家使用商用软件进行统计分析。
97例肝移植切除标本中共发现193个HCC，其中24.9%（48/193）在影像学上未被检测到。影像学上可见的145个HCC中，46.9%（68/145）表现为典型的快进快出模式（A模式），37.9%（55/145）表现为动脉期强化但无廓清（B模式），15.2%（22/145）在动脉期和静脉期序列上表现为低血供（C模式）。A模式仅见于HCC。55个表现为B模式的HCC中有23个在肝胆期也呈低信号（B1模式）。将B1模式与A模式相结合可使HCC特征性表现的敏感性从46.9%提高到62.8%（P = 0.007），而特异性无显著降低。
与A模式相结合时，B1模式可提高HCC特征性表现的敏感性，且特异性无显著降低。
