序贯式钆塞酸增强肝脏 MRI 对 CT 增强扫描中发现的小（10-19mm）或不典型肝脏病灶的诊断价值：一项前瞻性比较。
Added Value of sequentially performed gadoxetic acid-enhanced liver MRI for the diagnosis of small (10-19 mm) or atypical hepatic observations at contrast-enhanced CT: A prospective comparison.
机构信息
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
College of Medicine, Seoul, Republic of Korea.
出版信息
J Magn Reson Imaging. 2019 Feb;49(2):574-587. doi: 10.1002/jmri.26199. Epub 2018 Aug 13.
BACKGROUND
Small hepatocellular carcinomas (HCCs) often show atypical features at cross-sectional imaging, yet there is no preferred recommendation for the diagnosis or characterization of small observations (10-19 mm) at present.
PURPOSE
To determine the added value of sequentially performed gadoxetic acid-enhanced liver MRI for contrast-enhanced computed tomography (CECT)-detected small (10-19 mm) or atypical hepatic observations ≥20 mm in the diagnosis of HCC.
STUDY TYPE
Prospective, cross-sectional, intraindividual comparison.
POPULATION
In all, 110 patients at high risk of developing HCC.
FIELD STRENGTH/SEQUENCE: 1.5T and 3T/T -weighted imaging.
ASSESSMENT
Hepatic observations were classified into HCCs or benign non-HCCs based on imaging features of arterial phase hyperenhancement (APHE) and portal or delayed washout at CT or APHE and portal washout at MRI. Final diagnoses were established using a composite algorithm and diagnostic performances of MRI and CT were compared in all observations. In addition, in a subgroup of histologically confirmed observations and stable benign observations during follow-up (n = 94), sensitivity and specificity of MRI were compared between the aforementioned criteria and LR-5 of Liver Imaging Reporting and Data System v2014.
STATISTICAL TEST
χ test.
RESULTS
MRI provided higher sensitivity than CT (62.2% vs. 27.0%, P = 0.0001) while maintaining specificity (97.2%, each) at the per-patient level. Among 124 observations, 10-19 mm in size, MRI showed significantly higher sensitivity in diagnosing HCCs (62.5%, 50/80) than CT (25%, 20/80, P < 0.0001) with comparable specificity (97.7% [43/44], each). However, seven atypical observations (≥20 mm) at CT remained atypical at MRI. In the subgroup analysis, the diagnostic criteria of APHE and portal washout showed a significantly higher sensitivity (44.2%, 19/43) than LR-5 (23.2%, 10/43, P = 0.004), without compromising specificity (97.7% vs. 95.5%).
DATA CONCLUSION
Sequentially performed gadoxetic acid-enhanced MRI provided added value to CECT for the diagnosis of HCCs in small observations by improving sensitivity while maintaining specificity.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:574-587.
背景
小肝细胞癌（HCC）在横断面成像时常表现出非典型特征，但目前对于小（10-19mm）或≥20mm的非典型肝观察的诊断或特征描述尚无首选推荐。
目的
确定连续进行钆塞酸增强肝脏 MRI 对 CT 增强（CECT）检测的小（10-19mm）或≥20mm的不典型肝观察在 HCC 诊断中的附加价值。
研究类型
前瞻性、横断面、个体内比较。
人群
所有高危 HCC 患者 110 例。
磁场强度/序列：1.5T 和 3T/T1 加权成像。
评估
根据动脉期强化（APHE）和 CT 门静脉或延迟洗脱、MRI 门静脉洗脱的影像学特征，将肝观察分为 HCC 或良性非 HCC。最终诊断采用综合算法，比较 MRI 和 CT 在所有观察中的诊断性能。此外，在一组组织学证实的观察和随访中稳定的良性观察（n=94）中，比较了上述标准和 2014 年肝脏成像报告和数据系统 v2014 的 LR-5 的 MRI 敏感性和特异性。
统计学检验
卡方检验。
结果
MRI 在每位患者水平上提供了比 CT 更高的敏感性（62.2%比 27.0%，P=0.0001），同时保持特异性（97.2%，各）。在 124 个 10-19mm 大小的观察中，MRI 诊断 HCC 的敏感性显著高于 CT（62.5%，50/80）（P<0.0001），特异性相似（97.7%[43/44]，各）。然而，CT 上七个≥20mm 的非典型观察仍为 MRI 上的非典型。在亚组分析中，APHE 和门静脉洗脱的诊断标准显示出比 LR-5（44.2%，19/43）更高的敏感性（P=0.004），而特异性没有降低（97.7%比 95.5%）。
数据结论
连续进行钆塞酸增强 MRI 为 CECT 诊断小 HCC 提供了附加价值，提高了敏感性而不影响特异性。
证据水平
2 技术功效：2 期 J. Magn. Reson. Imaging 2019;49:574-587.
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