Kim Bohyun, Lee Jei Hee, Kim Jai Keun, Kim Hye Jin, Kim Young Bae, Lee Dakeun
Department of Radiology Department of Pathology, Ajou University School of Medicine, Suwon-si, Republic of Korea.
Medicine (Baltimore). 2018 Jun;97(25):e11142. doi: 10.1097/MD.0000000000011142.
This study aimed to evaluate the capability of gadoxetic acid-enhanced MR (GAeMR) to detect presence of capsule appearance in hepatocellular carcinoma (HCC), and to correlate it with dynamic computed tomography (CT) and pathological features.Sixty-three patients (54: 9 = M: F, mean age 55.8) surgically confirmed HCCs with preoperative CT and GAeMR were included in this retrospective study. Two readers evaluated presence of capsule appearances on CT and GAeMR images in each phase including precontrast (Pre), portal phase (PP), delayed phase (DP), transitional phase (TP), and hepatobiliary phase (HBP). Histologic capsule was compared with CT and GAeMR. Diagnostic performance of CT and GAeMR of each phase for histologic capsule was evaluated and compared by receiver operating characteristic curve. Interobserver agreement was assessed with kappa statistics.Histologically the capsule was complete in 12.7% (8/63) and incomplete in 60.3% (38/63). Four cases (6.3%) were pseudocapsule. Interobserver agreement for capsule appearance on GAeMR was good in Pre (κ = 0.684), moderate in PP (κ = 0.434), poor in TP (κ = 0.187), fair in HBP (κ = 0.395), and moderate on CT in PP (κ = 0.476) and DP (κ = 0.485). Diagnostic performance and sensitivity for the histologic capsule in DP on CT was highest among PP on CT and other phases on GAeMR. DP on CT images showed a higher Az value than PP on CT images with statistical significance (P < .001). PP on MR images revealed higher Az value than PP on CT images.The capsule appearance was most frequently observed in the DP on CT with highest diagnostic performance, and so DP images should be obtained on CT study for liver mass categorization. GAeMR yielded comparable capsule appearance to CT with moderate interobserver agreement. Considering hypointense rim on the HBP as fibrous capsule on pathology should be refrained, and so further study is warranted to correlate HBP hypointense rim with pathologic findings.
本研究旨在评估钆塞酸二钠增强磁共振成像（GAeMR）检测肝细胞癌（HCC）包膜表现的能力，并将其与动态计算机断层扫描（CT）及病理特征相关联。本回顾性研究纳入了63例经手术证实的HCC患者（男∶女 = 54∶9，平均年龄55.8岁），这些患者术前均接受了CT和GAeMR检查。两名阅片者评估了每个时期（包括平扫期（Pre）、门静脉期（PP）、延迟期（DP）、移行期（TP）和肝胆期（HBP））CT和GAeMR图像上的包膜表现。将组织学包膜与CT和GAeMR结果进行比较。通过绘制受试者工作特征曲线评估并比较CT和各时期GAeMR对组织学包膜的诊断性能。采用kappa统计量评估观察者间的一致性。组织学检查显示，12.7%（8/63）的包膜完整，60.3%（38/63）的包膜不完整。4例（6.3%）为假包膜。GAeMR上包膜表现的观察者间一致性在平扫期良好（κ = 0.684），门静脉期中等（κ = 0.434），移行期较差（κ = 0.187），肝胆期一般（κ = 0.395）；CT上门静脉期（κ = 0.476）和延迟期（κ = 0.485）的观察者间一致性中等。CT延迟期对组织学包膜的诊断性能和敏感性在CT门静脉期及GAeMR其他时期中最高。CT图像延迟期的Az值高于CT图像门静脉期，差异有统计学意义（P < 0.001）。MR图像门静脉期的Az值高于CT图像门静脉期。CT延迟期包膜表现最常见且诊断性能最高，因此肝脏肿块分类的CT检查应获取延迟期图像。GAeMR的包膜表现与CT相当，观察者间一致性中等。不应将肝胆期的低信号边缘视为病理上的纤维包膜，因此有必要进一步研究肝胆期低信号边缘与病理结果的相关性。
