Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
Department of Visceral Surgery, University Hospital of Tuebingen, Tuebingen, Germany.
Cancer Imaging. 2018 Mar 7;18(1):10. doi: 10.1186/s40644-018-0140-1.
To investigate the added diagnostic value of diffusion-weighted imaging (DWI) of the liver and its impact on therapy decisions in patients with hepatic malignancy.
Interdisciplinary gastrointestinal tumorboard cases concerning patients with hepatic malignancies discussed between 11/2015 and 06/2016 were included in this retrospective, single-center study. Two radiologists independently reviewed the respective liver MR-examination first without, then with DWI. The readers were blinded regarding number, position and size of hepatic malignancies. Cases in which DWI revealed additional findings concerning the hepatic tumor status as compared to conventional sequences alone were presented to experienced members of the interdisciplinary tumor board. In this retrospective setting changes in treatment decisions based on these additional findings in the DWI sequences were recorded.
A total of 87 patients were included. DWI revealed additional findings in 12 patients (13,8%). These new findings had a direct effect on the therapy in 8 patients (9,2%): In 6 patients (6,9%) the surgical/interventional treatment was adapted (n = 5: extended resection, n = 1: with transarterial chemoembolization of a single hepatocellular carcinoma only detectable in DWI); 2 patients (2,3%) received systemic therapy (n = 1: neo-adjuvant, n = 1: palliative) based on the additional findings in DWI. In 4 patients (4.6%) additional DWI findings did not affect the therapeutic decision.
DWI is a relevant diagnostic tool in oncologic imaging of the liver. By providing further information regarding tumor load in hepatic malignancies it can lead to a significant change in treatment.
研究肝脏弥散加权成像（DWI）在肝脏恶性肿瘤患者中的额外诊断价值及其对治疗决策的影响。
本回顾性单中心研究纳入了 2015 年 11 月至 2016 年 6 月间由胃肠肿瘤多学科专家会诊讨论的肝脏恶性肿瘤患者的病例。两名放射科医生分别独立对各自的肝脏磁共振检查进行了评估，首先是没有弥散加权成像的检查，然后是有弥散加权成像的检查。读者对肝脏恶性肿瘤的数量、位置和大小均不知情。当弥散加权成像相对于常规序列显示出肝脏肿瘤状态的额外发现时，将这些病例呈现给经验丰富的多学科肿瘤委员会成员。在这种回顾性的背景下，记录了基于弥散加权成像序列中的这些额外发现而改变的治疗决策。
共纳入 87 例患者。弥散加权成像在 12 例患者（13.8%）中发现了额外的发现。这些新的发现直接影响了 8 例患者（9.2%）的治疗：6 例患者（6.9%）的手术/介入治疗进行了调整（n=5：扩大切除，n=1：仅在弥散加权成像中检测到单个肝细胞癌时进行经动脉化疗栓塞）；2 例患者（2.3%）根据弥散加权成像中的额外发现接受了系统治疗（n=1：新辅助治疗，n=1：姑息治疗）。在 4 例患者（4.6%）中，额外的弥散加权成像发现没有影响治疗决策。
弥散加权成像在肝脏肿瘤的影像学诊断中是一种重要的工具。通过提供关于肝脏恶性肿瘤肿瘤负荷的进一步信息，它可以导致治疗的显著改变。
