体素增强对比磁共振成像和弥散加权成像在鉴别常见原发性富血供肝肿瘤中的应用。
Utility of volumetric contrast-enhanced and diffusion-weighted MRI in differentiating between common primary hypervascular liver tumors.
机构信息
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Siemens Healthcare, Baltimore, Maryland, USA.
出版信息
J Magn Reson Imaging. 2018 Oct;48(4):1080-1090. doi: 10.1002/jmri.26032. Epub 2018 Apr 6.
BACKGROUND
Differentiating between hepatocellular carcinoma (HCC), focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) is usually achievable by MRI. However, in some cases with atypical imaging findings accurate diagnosis may be difficult.
PURPOSE
To assess the diagnostic value of volumetric contrast-enhanced (CE) and volumetric diffusion-weighted imaging (DWI) in differentiating between HCC, FNH, and HCA.
STUDY TYPE
Retrospective.
SUBJECTS
In all, 143 patients (206 lesions): 42 HCA (81 lesions), 51 FNH (65 lesions), and 50 HCC (60 lesions).
FIELD STRENGTH/SEQUENCE: 1.5T MRI, T -T WI, DWI.
ASSESSMENT
Patients underwent CE-MRI and DWI (b = 0, 750 mm /s). Volumetric assessment of lesions' contrast enhancement and apparent diffusion coefficient (ADC) was performed with semiautomatic software after 3D image registration and segmentation by an observer and compared between three lesion groups. The diagnosis of lesions was based on histopathology, typical MRI findings, and/or follow-up.
STATISTICAL TESTS
Independent t-test was used to compare parameters between two groups, one-way analysis of variance (ANOVA) between three groups, and receiver operator characteristic curve (ROC) analysis to define under-curve area and optimal cutoff.
RESULTS
Mean values (±standard deviation) for HCC, FNH, and HCA, respectively, were: 1) arterial enhancement (%), 40.5 ± 13.2, 88.6 ± 32.6, 69.6 ± 25.1; 2) venous enhancement (%) 72.4 ± 22.1, 95.2 ± 30.9, 80.7 ± 30.6; and 3) ADC (10 mm /s) 1404.5 ± 168.1, 1413.4 ± 232.1, 1070.1 ± 232.1. ADC was the best differentiator of HCA from FNH (at 1211 × 10 mm /s; sensitivity 80.4%, specificity 71.7%) and arterial enhancement was the best differentiator of HCC from both HCA (at 48%; sensitivity 80.0%, specificity 80.5%) and FNH (at 52%; sensitivity 85.7%, specificity 85.4%). A combination of arterial enhancement and ADC (at 50% and 1227 × 10 mm /s) differentiated three types of tumors with high specificity (87.9%).
DATA CONCLUSION
Volumetric CE-MRI and volumetric DWI can help to differentiate between HCC, FNH, and HCA.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1080-1090.
背景
通过 MRI 通常可以区分肝细胞癌（HCC）、局灶性结节性增生（FNH）和肝细胞腺瘤（HCA）。然而，在一些具有非典型影像学表现的病例中，准确诊断可能具有一定难度。
目的
评估容积对比增强（CE）和容积扩散加权成像（DWI）在区分 HCC、FNH 和 HCA 中的诊断价值。
研究类型
回顾性。
受试者
共有 143 名患者（206 个病灶）：42 个 HCA（81 个病灶）、51 个 FNH（65 个病灶）和 50 个 HCC（60 个病灶）。
场强/序列：1.5T MRI、T1-T2WI、DWI。
评估
患者接受 CE-MRI 和 DWI（b=0、750mm/s）检查。通过 3D 图像配准和分割后，由观察者进行病变的容积增强和表观扩散系数（ADC）评估，并在三组病变之间进行比较。病变的诊断基于组织病理学、典型 MRI 表现和/或随访。
统计学检验
使用独立 t 检验比较两组间的参数，使用单因素方差分析（ANOVA）比较三组间的参数，使用受试者工作特征曲线（ROC）分析定义曲线下面积和最佳截断值。
结果
HCC、FNH 和 HCA 的平均（±标准差）值分别为：1）动脉增强（%），40.5±13.2、88.6±32.6、69.6±25.1；2）静脉增强（%），72.4±22.1、95.2±30.9、80.7±30.6；3）ADC（10mm/s），1404.5±168.1、1413.4±232.1、1070.1±232.1。ADC 是区分 HCA 和 FNH 的最佳指标（在 1211×10mm/s 时；灵敏度 80.4%，特异性 71.7%），动脉增强是区分 HCC 和 HCA（在 48%时；灵敏度 80.0%，特异性 80.5%）和 FNH（在 52%时；灵敏度 85.7%，特异性 85.4%）的最佳指标。动脉增强和 ADC（分别为 50%和 1227×10mm/s）的组合具有较高的特异性（87.9%），可用于区分三种类型的肿瘤。
数据结论
容积 CE-MRI 和容积 DWI 有助于区分 HCC、FNH 和 HCA。
证据水平
1 技术功效：2 级 J. Magn. Reson. Imaging 2018；48：1080-1090。
Zotero 插件