From the Department of Radiology (B.R.K., J.M.L., D.H.L., J.H.Y., J.K.H.), Institute of Radiation Medicine (J.M.L., J.K.H.), Department of General Surgery (K.S.S., N.J.Y.), and Department of Pathology (K.B.L.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.).
Radiology. 2017 Oct;285(1):134-146. doi: 10.1148/radiol.2017162080. Epub 2017 Jun 13.
Purpose To compare the diagnostic performance of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging with that of contrast material-enhanced multidetector computed tomography (CT) in the detection of borderline hepatocellular nodules in patients with liver cirrhosis and to determine the Liver Imaging Reporting and Data System (LI-RADS) categories of these detected nodules. Materials and Methods The institutional review board approved this retrospective study and waived the informed consent requirement. Sixty-eight patients with pathologically proven dysplastic nodules (DNs) (low-grade DNs, n = 20; high-grade DNs, n = 17), early hepatocellular carcinomas (HCCs) (n = 42), or progressed HCCs (n = 33) underwent gadoxetic acid-enhanced MR imaging and multidetector CT. An additional 57 patients without any DNs or HCCs in the explanted livers were included as control subjects. Three radiologists independently graded the presence of liver nodules on a five-point confidence scale and assigned LI-RADS categories by using imaging findings. Jackknife alternative free-response receiver operating characteristics (JAFROC) software was used to compare the diagnostic accuracy of each modality in lesion detection. Results Reader-averaged figures of merit estimated with JAFROC software to detect hepatocellular nodules were 0.774 for multidetector CT and 0.842 for MR imaging (P = .002). Readers had significantly higher detection sensitivity for early HCCs with MR imaging than with multidetector CT (78.6% vs 52.4% [P = .001], 71.4% vs 50.0% [P = .011], and 73.8% vs 50.0% [P = .001], respectively). A high proportion of overall detected early HCCs at multidetector CT (59.4%) and MR imaging (72.3%) were categorized as LI-RADS category 4. Most early HCCs (76.2%) and high-grade DNs (82.4%) demonstrated hypointensity on hepatobiliary phase images. In total, 30 more LI-RADS category 4 early HCCs were identified with MR imaging than with multidetector CT across all readers. Conclusion Gadoxetic acid-enhanced MR imaging performed significantly better in the detection of high-risk borderline nodules, especially early HCCs, than did multidetector CT. RSNA, 2017 Online supplemental material is available for this article.
比较钆塞酸增强肝脏磁共振成像（MR）与多排 CT 对比增强在肝硬化患者边界性肝细胞结节检测中的诊断性能，并确定这些检测结节的肝脏成像报告和数据系统（LI-RADS）分类。
本回顾性研究经机构审查委员会批准，并豁免了知情同意书的要求。68 例经病理证实为异型增生结节（DN）（低级别 DN，20 例；高级别 DN，17 例）、早期肝细胞癌（HCC）（42 例）或进展性 HCC（33 例）患者接受了钆塞酸增强 MR 成像和多排 CT 检查。另外，57 例在肝切除标本中无任何 DN 或 HCC 的患者作为对照。3 名放射科医生独立地对 5 分置信度量表上的肝脏结节存在情况进行分级，并根据影像学表现对 LI-RADS 类别进行赋值。使用 Jackknife alternative free-response receiver operating characteristics（JAFROC）软件比较每种方法在检测病变中的诊断准确性。
使用 JAFROC 软件估计，多排 CT 和 MR 成像检测肝细胞结节的读者平均特征值分别为 0.774 和 0.842（P =.002）。与多排 CT 相比，MR 成像对早期 HCC 的检测敏感性显著更高（78.6%比 52.4%[P =.001]，71.4%比 50.0%[P =.011]，73.8%比 50.0%[P =.001]）。多排 CT（59.4%）和 MR 成像（72.3%）检测到的大多数早期 HCC 均归类为 LI-RADS 类别 4。大多数早期 HCC（76.2%）和高级别 DN（82.4%）在肝胆期图像上呈低信号。在所有读者中，MR 成像共检出 30 例多排 CT 漏诊的 LI-RADS 类别 4 早期 HCC。
与多排 CT 相比，钆塞酸增强 MR 成像在检测高危边界性结节（尤其是早期 HCC）方面表现出更好的性能。
