Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
Eur Radiol. 2018 Apr;28(4):1551-1559. doi: 10.1007/s00330-017-5119-y. Epub 2017 Nov 13.
To determine the value of a 15-min delayed phase in extracellular contrast agent (ECA)-enhanced magnetic resonance imaging (MRI) for evaluation of hepatocellular carcinoma (HCC) in patients with chronic liver disease.
Between 2014 and 2015, 103 patients with chronic liver disease underwent ECA-enhanced MRI; 133 lesions consisting of 107 HCCs, 23 benign lesions and three non-HCC malignancies were identified with pathological or clinical diagnosis. MRI images were reviewed by two abdominal radiologists independently using the European Association for the Study of the Liver (EASL) and Liver Imaging Reporting and Data System (LI-RADS) criteria. Imaging features observed in the 15-min delayed phase were recorded.
Of 107 HCCs, three or four additional HCCs were diagnosed according to the EASL criteria by adding the 15-min delayed phase, increasing sensitivity (Reviewer 1, from 69.2-72.0 % [P = 0.072]; Reviewer 2, from 75.7-79.4 % [P = 0.041]). Reviewers 1 and 2 upgraded one and four HCCs from LR-4 to LR-5 based on the LI-RADS, respectively. Among 23 benign lesions, no additional findings were observed in the 15-min delayed phase.
Including the 15-min delayed phase in ECA-enhanced MRI may improve the diagnostic performance for HCC in patients with chronic liver disease.
• Additional acquisition of 15-min delayed phase (FDP) requires approximately 20 s. • About 5 % of HCCs show washout or capsule appearance only in FDP. • Including FDP improves the sensitivity of extracellular contrast agent-enhanced MRI for HCC. • These results are applicable only to patients with chronic liver disease.
探讨在慢性肝病患者中，使用细胞外对比剂（ECA）增强磁共振成像（MRI）行 15 分钟延迟扫描，对肝细胞癌（HCC）的诊断价值。
回顾性分析 2014 年至 2015 年期间，103 例慢性肝病患者的 ECA 增强 MRI 资料。根据病理或临床诊断，共检出 133 个病灶，包括 107 个 HCC、23 个良性病变和 3 个非 HCC 恶性肿瘤。由 2 名腹部放射科医生独立使用欧洲肝脏研究协会（EASL）和肝脏影像报告和数据系统（LI-RADS）标准进行 MRI 图像评价。记录 15 分钟延迟期的影像学特征。
根据 EASL 标准，在加入 15 分钟延迟期后，诊断出 3 个或 4 个 HCC，从而提高了诊断的敏感性（观察者 1：从 69.2%至 72.0%[P=0.072]；观察者 2：从 75.7%至 79.4%[P=0.041]）。观察者 1 和 2 根据 LI-RADS 将 1 个和 4 个 HCC 从 LR-4 升级为 LR-5。23 个良性病变中，在 15 分钟延迟期无新的发现。
在 ECA 增强 MRI 中加入 15 分钟延迟期可能会提高慢性肝病患者 HCC 的诊断性能。
额外采集 15 分钟延迟期（FDP）大约需要 20 秒。
大约 5%的 HCC 在 FDP 仅表现为洗脱或包膜样外观。
包括 FDP 可提高细胞外对比剂增强 MRI 对 HCC 的敏感性。
这些结果仅适用于慢性肝病患者。
