Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Republic of Korea.
Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
Abdom Radiol (NY). 2018 Sep;43(9):2309-2320. doi: 10.1007/s00261-018-1480-9.
To assess the added value of intratumoral ancillary features to conventional enhancement pattern-based diagnosis of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI).
A total of 773 consecutive patients with surgically resected 773 primary hepatic tumors (699 HCCs, 63 intrahepatic cholangiocarcinomas, and 11 benign nodules) who underwent gadoxetic acid-enhanced MRI were retrospectively identified. Enhancement patterns and three ancillary features of capsule, septum, and T2 spotty hyperintensity were assessed by two radiologists. Performance of enhancement pattern-based diagnosis of HCC was compared to diagnosis of HCC based on enhancement pattern plus ancillary features.
Enhancement patterns were positive (arterial diffuse hyperenhancement with washout) for 562 (72.7%) tumors, negative (no arterial hyperenhancement and no washout) for 75 (9.7%), and inconclusive (either no arterial hyperenhancement or no washout) for 136 (17.6%). Capsule was observed in 498 (64.4%) tumors, septum in 521 (67.3%), and T2 spotty hyperintensity in 107 (13.8%). The accuracy and sensitivity of HCC diagnosis was improved significantly after adding at least one ancillary feature compared with enhancement pattern-based diagnosis of HCCs (79.9% vs. 91.1% for accuracy, p < 0.0001 and 79.1% vs. 92.0% for sensitivity, p < 0.0001) with a minor tradeoff in specificity (87.8% vs. 82.4%, p = 0.125). Adding at least two ancillary features improved accuracy (88.1%, p < 0.0001) and sensitivity (88.1%, p < 0.0001) without changing specificity (87.8%, p = 1.0).
Adding intratumoral ancillary features of capsule, septum and T2 spotty hyperintensity to conventional enhancement patterns on gadoxetic acid-enhanced MRI improved accuracy and sensitivity, while maintaining specificity for HCC diagnosis.
评估钆塞酸增强磁共振成像（MRI）中肿瘤内辅助特征对常规增强模式诊断肝细胞癌（HCC）的附加价值。
回顾性分析了 773 例经手术切除的 773 例原发性肝肿瘤（699 例 HCC、63 例肝内胆管细胞癌和 11 例良性结节）患者的资料，这些患者均接受了钆塞酸增强 MRI 检查。由两位放射科医生评估增强模式和包膜、间隔和 T2 点状高信号这三种辅助特征。将 HCC 的增强模式诊断与基于增强模式和辅助特征的 HCC 诊断进行比较。
562 例（72.7%）肿瘤的增强模式为阳性（动脉期弥漫性高强化伴廓清），75 例（9.7%）为阴性（无动脉期高强化和廓清），136 例（17.6%）为不确定（要么无动脉期高强化，要么无廓清）。498 例（64.4%）肿瘤有包膜，521 例（67.3%）肿瘤有间隔，107 例（13.8%）肿瘤 T2 点状高信号。与基于增强模式的 HCC 诊断相比，至少增加一种辅助特征后，HCC 诊断的准确性和敏感度显著提高（准确性为 79.9%比 91.1%，p<0.0001，敏感度为 79.1%比 92.0%，p<0.0001），而特异性略有下降（87.8%比 82.4%，p=0.125）。至少增加两种辅助特征可提高准确性（88.1%，p<0.0001）和敏感度（88.1%，p<0.0001），而不改变特异性（87.8%，p=1.0）。
在钆塞酸增强 MRI 中，将肿瘤内包膜、间隔和 T2 点状高信号等辅助特征与常规增强模式相结合，可提高 HCC 诊断的准确性和敏感度，同时保持特异性。
