Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Korean J Radiol. 2018 Jul-Aug;19(4):568-577. doi: 10.3348/kjr.2018.19.4.568. Epub 2018 Jun 14.
To preliminarily evaluate the diagnostic performance of an unenhanced MRI for detecting hepatocellular carcinoma (HCC) with a case-control study design.
The case group consisted of 175 patients with initially-diagnosed HCC, who underwent a 3T liver MRI. A total of 237 HCCs were identified. The number of HCCs that were smaller than 1 cm, 1 cm ≤ and < 2 cm, and ≥ 2 cm were 19, 105, and 113, respectively. For the control group, 72 patients with chronic liver disease, who did not have HCC, were enrolled. Two radiologists independently reviewed the T2 half-Fourier acquisition single-shot turbo spin echo, T2 fast spin echos with fat saturation, T1 gradient in- and out-of-phase images, and diffusion-weighted images/apparent diffusion coefficient maps to detect HCC. Per-patient analyses were performed to evaluate the sensitivity and specificity of the non-contrast MRI for diagnosing HCC. Furthermore, the per-lesion sensitivity was also calculated according to tumor size.
In the per-patient analyses, the sensitivity and specificity of reader 1 were 86.3% (151/175) and 87.5% (63/72), respectively; while those of reader 2 were 82.9% (145/175) and 76.4% (55/72), respectively. When excluding HCCs smaller than 1 cm, the sensitivity of reader 1 and 2 were 88.0% (147/167) and 86.2% (144/167), respectively. In the per-lesion analyses, the sensitivities of reader 1 and reader 2 were 75.9% (180/237) and 70.5% (167/237), respectively.
The per-patient sensitivity and specificity of non-contrast MRIs were within a reasonable range for the initial diagnosis of HCC. Non-contrast MRIs may have a potential for surveillance of HCC. Further confirmatory diagnostic test accuracy studies are needed.
采用病例对照研究设计，初步评估平扫 MRI 诊断肝细胞癌（HCC）的诊断性能。
病例组由 175 例初诊 HCC 患者组成，所有患者均行 3T 肝脏 MRI 检查。共检出 237 个 HCC 病灶，其中直径＜1cm、1cm≤且＜2cm、≥2cm 的 HCC 分别为 19、105、113 个。对照组为 72 例无 HCC 的慢性肝病患者。由 2 名放射科医师独立分析 T2 半傅里叶采集单次激发快速自旋回波、T2 快速自旋回波脂肪饱和序列、T1 梯度正反相位成像和弥散加权成像/表观弥散系数图，以检测 HCC。对每位患者进行分析，评估平扫 MRI 诊断 HCC 的敏感度和特异度。同时，根据肿瘤大小计算病变水平的敏感度。
在每位患者的分析中，医师 1 的敏感度和特异度分别为 86.3%（151/175）和 87.5%（63/72），医师 2 的敏感度和特异度分别为 82.9%（145/175）和 76.4%（55/72）。当排除直径＜1cm 的 HCC 后，医师 1 和 2 的敏感度分别为 88.0%（147/167）和 86.2%（144/167）。在病变水平的分析中，医师 1 和医师 2 的敏感度分别为 75.9%（180/237）和 70.5%（167/237）。
平扫 MRI 诊断 HCC 的患者水平敏感度和特异度在合理范围内，平扫 MRI 可能有用于 HCC 监测的潜力，需要进一步进行确认诊断试验准确性的研究。
