Bae Jae Seok, Kim Jung Hoon, Yu Mi Hye, Lee Dong Ho, Kim Hyo-Cheol, Chung Jin Wook, Han Joon Koo
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
PLoS One. 2017 May 30;12(5):e0178495. doi: 10.1371/journal.pone.0178495. eCollection 2017.
BACKGROUND & AIMS: To assess diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma (HCC) detected by C-arm CT and concordance rate of Liver Imaging Reporting and Data System (LI-RADS).
In this retrospective study, we recruited 4,544 patients suspected of having HCC underwent C-arm CT from November 2008 to May 2013. Among these patients, gadoxetic acid-enhanced MR was performed in 167 patients with HCC (n = 379; 257 > 1 cm, 122 ≤ 1 cm). HCC was confirmed by MR, CT, or follow-up images. Two radiologists graded likelihood of HCC and assessed MR features. Jackknife alternative free-response receiver operating characteristic (JAFROC) analysis was performed. All HCCs were evaluated concordance rate of LI-RADS.
Mean JAFROC figure of merit for large (>1-cm) HCC was 0.948, while that for small HCC was 0.787 with fair agreement (κ = 0.409). Mean sensitivity and positive predictive value (PPV) were 91% and 90% for large HCC versus 63.0% and 79% for small HCC, respectively. Seventeen of 122 small HCCs (13.9%) were not visible on MR. Among 379 HCCs, 99 met LR-5, and 259 met LR-4. Common features for small HCC included arterial enhancement (81.9%), hepatobiliary phase hypointensity (80.3%), and delayed washout (72.9%).
Diagnostic accuracy of gadoxetic acid-enhanced MR imaging for small, hypervascular HCCs (Mean figure of merit = 0.787) was still low compared with large HCC (Mean figure of merit = 0.948). LR-5 and LR-4 covered 94% (358/379) of the HCCs.
评估钆塞酸二钠增强磁共振成像（MR）对C臂CT检测出的小的富血管肝细胞癌（HCC）的诊断准确性以及肝脏影像报告和数据系统（LI-RADS）的符合率。
在这项回顾性研究中，我们纳入了2008年11月至2013年5月期间4544例疑似患有HCC且接受了C臂CT检查的患者。在这些患者中，167例HCC患者（共379个病灶；257个病灶直径>1 cm，122个病灶直径≤1 cm）接受了钆塞酸二钠增强MR检查。HCC通过MR、CT或随访影像得以确诊。两名放射科医生对HCC的可能性进行分级并评估MR特征。采用刀切法替代自由反应接受者操作特征（JAFROC）分析。对所有HCC评估LI-RADS的符合率。
大的（>1 cm）HCC的平均JAFROC品质因数为0.948，而小HCC的平均JAFROC品质因数为0.787，一致性一般（κ=0.409）。大HCC的平均敏感性和阳性预测值（PPV）分别为91%和90%，而小HCC分别为63.0%和79%。122个小HCC中有17个（13.9%）在MR上不可见。在379个HCC中，99个符合LR-5，259个符合LR-4。小HCC的常见特征包括动脉期强化（81.9%）、肝胆期低信号（80.3%）和延迟期廓清（72.9%）。
与大HCC（平均品质因数=0.948）相比，钆塞酸二钠增强MR成像对小的富血管HCC的诊断准确性（平均品质因数=0.787）仍然较低。LR-5和LR-4涵盖了94%（358/379）的HCC。
