Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany.
Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Germany.
Eur J Radiol. 2017 Sep;94:85-92. doi: 10.1016/j.ejrad.2017.06.009. Epub 2017 Jun 17.
To evaluate the diagnostic accuracy of the individual sequences of a clinical routine liver MRI protocol for the detection of local tumour progression after radiofrequency (RF) ablation of hepatic malignancies.
A cohort of 93 patients treated for 140 primary and secondary hepatic malignancies with RF ablation was assembled for this retrospective study. The cohort contained 31 cases of local tumour progression, which occurred 8.3±6.2months (range: 4.0-28.2 months) after treatment. All patients underwent clinical routine follow-up MRI at 1.5T including following sequences: unenhanced T1-weighted fast low angle shot (FLASH-2D), T2-weighted turbo-spin-echo sequence, contrast-enhanced (CE) T1-weighted volume-interpolated breath-hold examination (VIBE), diffusion-weighted imaging (DWI). Follow-up was 32.7±22.5months (range: 4.0-138.3 months). Two readers independently evaluated the individual sequences separately for signs of local tumour progression. Diagnostic confidence was rated on a 4-point scale. Inter-reader agreement was assessed with Coheńs kappa. Long-term follow-up and histological specimen served as standard of reference.
Both readers reached the highest sensitivity for detection of local tumour progression with unenhanced T1-FLASH 2D (88.2% and 94.1%, respectively) and the highest specificity with CE T1-VIBE (96.2% and 97.2%, respectively). Highest inter-reader agreement was reached with T1-FLASH-2D (kappa=0.83). Typical pitfalls for false-positive diagnoses were focal cholestasis and vasculature adjacent to the ablation zone. Diagnostic confidence was highest with CE T1-VIBE for reader 1 and DWI for reader 2.
Unenhanced T1-FLASH-2D is an essential sequence for follow-up imaging after tumour ablation with a high sensitivity for detection of local progression and a high inter-reader agreement.
评估临床常规肝脏 MRI 方案各序列在检测射频（RF）消融治疗肝恶性肿瘤后局部肿瘤进展的诊断准确性。
本回顾性研究共纳入 93 例接受 RF 消融治疗的 140 例原发性和继发性肝恶性肿瘤患者。该队列中有 31 例局部肿瘤进展，发生于治疗后 8.3±6.2 个月（范围：4.0-28.2 个月）。所有患者均在 1.5T 上接受临床常规随访 MRI 检查，包括以下序列：未增强 T1 加权快速低角度激发（FLASH-2D）、T2 加权涡轮自旋回波序列、对比增强（CE）T1 加权容积内插屏气检查（VIBE）、扩散加权成像（DWI）。随访时间为 32.7±22.5 个月（范围：4.0-138.3 个月）。两位读者分别独立评估各序列的局部肿瘤进展征象。诊断置信度评分为 4 分制。采用 Cohen κ 评估读者间的一致性。长期随访和组织学标本作为标准参考。
两位读者在检测局部肿瘤进展方面均达到了未增强 T1-FLASH 2D 的最高敏感性（分别为 88.2%和 94.1%）和 CE T1-VIBE 的最高特异性（分别为 96.2%和 97.2%）。T1-FLASH-2D 达到了最高的读者间一致性（κ=0.83）。假阳性诊断的典型陷阱是局灶性胆汁淤积和消融区域附近的血管。读者 1 认为 CE T1-VIBE 的诊断置信度最高，读者 2 认为 DWI 的诊断置信度最高。
未增强 T1-FLASH-2D 是肿瘤消融后随访成像的基本序列，对检测局部进展具有较高的敏感性和读者间一致性。
