Department of Radiology, Military Manpower Administration, Daejeon, South Korea.
Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwang-Ju, 61469, South Korea.
Abdom Radiol (NY). 2017 Oct;42(10):2527-2537. doi: 10.1007/s00261-017-1146-z.
To prospectively compare multidetector-row CT (MDCT) and MR imaging (MRI) in the assessment of the ablative margin (AM) and index tumor immediately after radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) and assess whether non-contrast MRI with limited sequences (T1- and T2-weighted imaging only) was superior to a conventional MDCT protocol.
A total of 33 consecutive patients with 42 HCCs were included in this study. Both MDCT and MR images were independently reviewed by two radiologists regarding the ability to visually discriminate between the AM and index tumor, and the AM status within ablation zones. The AM status was classified as AM-plus (AM completely surrounding the tumor), AM-zero (AM was partly discontinuous, without protrusion of the tumor), and AM-minus (AM was partly discontinuous, with protrusion of the tumor). During the follow-up period, the cumulative local tumor progression rates were analyzed using the Kaplan-Meier method and Cox proportional hazards model. To determine the added value of contrast-enhanced MR images, both reviewers separately evaluated the two sets (unenhanced and enhanced) of MR images.
Visual discrimination between the AM and index tumor was possible in four (9.5%) and 34 (81%) of the 42 ablation zones using MDCT and MRI, respectively (p < 0.001). Thirty-eight and four cases were classified as AM-plus and AM-zero on MDCT images, respectively, whereas the ablation zones were categorized as AM-plus (n = 32), AM-zero (n = 9), and AM-minus (n = 1) when examining the MR images. The cumulative incidence of local tumor progression was significantly lower in cases with AM-plus on MRI (p = 0.007). Contrast-enhanced MRI had no added value for the assessment of the AM and index tumor.
MRI was superior to MDCT for the differential assessment of the AM and index tumor immediately after RF ablation for HCC. Non-contrast MRI was also superior to the conventional MDCT protocol.
前瞻性比较多排螺旋 CT（MDCT）和磁共振成像（MRI）在射频（RF）消融治疗肝细胞癌（HCC）后即刻评估消融边缘（AM）和指数肿瘤中的作用，并评估仅使用有限序列（仅 T1 和 T2 加权成像）的非对比 MRI 是否优于常规 MDCT 方案。
本研究共纳入 33 例 42 个 HCC 患者。两位放射科医生分别对 MDCT 和 MR 图像进行独立评估，以评估其在视觉上区分 AM 和指数肿瘤以及 AM 在消融区域内的能力。将 AM 状态分为 AM-（AM 完全环绕肿瘤）、AM-（AM 部分不连续，无肿瘤突出）和 AM-（AM 部分不连续，肿瘤突出）。在随访期间，使用 Kaplan-Meier 方法和 Cox 比例风险模型分析累积局部肿瘤进展率。为了确定增强 MRI 的附加价值，两位观察者分别评估了两组（增强和未增强）MR 图像。
使用 MDCT 和 MRI 分别可在 42 个消融区域中的 4 个（9.5%）和 34 个（81%）中进行 AM 与指数肿瘤的视觉区分（p<0.001）。MDCT 图像上分别有 38 个和 4 个病例分类为 AM-和 AM-，而在 MRI 检查时，将消融区域分类为 AM-（n=32）、AM-（n=9）和 AM-（n=1）。MRI 上 AM-的病例局部肿瘤进展的累积发生率明显较低（p=0.007）。增强 MRI 对 AM 和指数肿瘤的评估没有附加价值。
MRI 对 HCC 射频消融后即刻评估 AM 和指数肿瘤优于 MDCT。非对比 MRI 也优于常规 MDCT 方案。
