肝细胞癌患者钆乙氧基苄基二乙三胺五乙酸增强磁共振成像上非高血管性低信号结节的存在情况
Presence of non-hypervascular hypointense nodules on Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in patients with hepatocellular carcinoma.
作者信息
Inoue Masanori, Ogasawara Sadahisa, Chiba Tetsuhiro, Ooka Yoshihiko, Wakamatsu Toru, Kobayashi Kazufumi, Suzuki Eiichiro, Tawada Akinobu, Yokosuka Osamu
机构信息
Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
出版信息
J Gastroenterol Hepatol. 2017 Apr;32(4):908-915. doi: 10.1111/jgh.13622.
BACKGROUND AND AIMS
Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) performed before curative therapy for hepatocellular carcinoma (HCC) can distinguish between intrahepatic distant recurrence and hypervascularization. This study aimed to retrospectively evaluate the presence of non-hypervascular hypointense nodules on hepatobiliary phase images from Gd-EOB-DTPA-enhanced MRI as a risk factor of the intrahepatic distant recurrence of early stage HCC following radiofrequency ablation (RFA).
METHODS
A total of 132 patients who underwent preprocedural Gd-EOB-DTPA-enhanced MRI followed by initial RFA were retrospectively analyzed. Post-RFA intrahepatic distant recurrence, which excluded the hypervascularization of non-hypervascular hypointense nodules detected by preprocedural Gd-EOB-DTPA-enhanced MRI, was evaluated according to the presence of non-hypervascular hypointense nodules on preprocedural Gd-EOB-DTPA-enhanced MRI.
RESULTS
Intrahepatic distant recurrence rates following RFA were higher in patients with non-hypervascular hypointense nodules (1-year: 22.5%, 2-year: 52.1%, 5-year: 89.1%) compared with in patients without non-hypervascular hypointense nodules (1-year: 7.0%, 2-year: 28.8%, 5-year: 48.7%). The presence of non-hypervascular hypointense nodules was associated with markedly increased cumulative recurrence rates of both identical and different subsegment intrahepatic distant recurrence, being an independent risk factor for post-RFA identical and different subsegment intrahepatic distant recurrence (identical: HR = 2.365, P = 0.027; different: HR = 3.276, P < 0.001).
CONCLUSION
The presence of non-hypervascular hypointense nodules on hepatobiliary phase images from Gd-EOB-DTPA-enhanced MRI obtained prior to RFA is an important predictive factor of intrahepatic distant recurrence following RFA of HCC.
背景与目的
在肝细胞癌（HCC）根治性治疗前进行的钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）能够区分肝内远处复发与血管增多。本研究旨在回顾性评估Gd-EOB-DTPA增强MRI肝胆期图像上非血管增多性低信号结节的存在情况，作为射频消融（RFA）治疗早期HCC后肝内远处复发的危险因素。
方法
对132例行术前Gd-EOB-DTPA增强MRI检查并随后接受初次RFA治疗的患者进行回顾性分析。根据术前Gd-EOB-DTPA增强MRI检查发现的非血管增多性低信号结节的情况，评估RFA术后排除了非血管增多性低信号结节血管增多的肝内远处复发情况。
结果
与无非血管增多性低信号结节的患者相比，有非血管增多性低信号结节的患者RFA术后肝内远处复发率更高（1年：22.5%，2年：52.1%，5年：89.1%），而无此类结节的患者1年、2年、5年复发率分别为7.0%、28.8%、48.7%。非血管增多性低信号结节的存在与肝内相同及不同亚段远处复发的累积复发率显著增加相关，是RFA术后肝内相同及不同亚段远处复发的独立危险因素（相同亚段：HR = 2.365，P = 0.027；不同亚段：HR = 3.276，P < 0.001）。
结论
RFA术前Gd-EOB-DTPA增强MRI肝胆期图像上非血管增多性低信号结节的存在是HCC患者RFA术后肝内远处复发的重要预测因素。
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