Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2019 Apr;29(4):1724-1732. doi: 10.1007/s00330-018-5727-1. Epub 2018 Sep 25.
To validate new diagnostic criteria for hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MR imaging (Gd-EOB-MRI) using hypointensity on the hepatobiliary phase (HBP) as an alternative to washout in combination with ancillary features.
This retrospective study included 288 patients at high risk for HCC with 387 nodules (HCCs, n=292; non-HCCs, n=95) showing arterial phase hyper-enhancement (APHE) ≥1 cm on Gd-EOB-MRI. Imaging diagnoses of HCCs were made using different criteria: APHE plus hypointensity on the portal venous phase (PVP) (criterion 1), APHE plus hypointensity on the PVP and/or transitional phase (TP) (criterion 2), APHE plus hypointensity on the PVP and/or TP and/or HBP (criterion 3), and criterion 3 plus non-LR-1/2/M according to the Liver Imaging Reporting and Data System (LI-RADS) v2017 considering ancillary features (criterion 4). Sensitivities and specificities of those criteria were compared using McNemar's test.
Among diagnostic criteria for HCCs, criteria 3 and 4 showed significantly higher sensitivities (93.8% and 92.5%, respectively) than criteria 1 and 2 (70.9% and 86.6%, respectively) (p values <0.001). The specificity of criterion 4 (87.4%) was shown to be significantly higher than that of criterion 3 (48.4%, p<0.001), albeit comparable to criterion 2 (86.3%, p>0.999) and significantly lower than criterion 1 (97.9%, p=0.002).
In the non-invasive diagnosis of HCCs on Gd-EOB-MRI, HBP hypointensity may be used as an alternative to washout enabling a highly sensitive diagnosis with little loss in specificity if it is used after excluding nodules considered to be benignities or non-HCC malignancies based on characteristic imaging features.
• Gd-EOB-MRI enhancement and ancillary features can be used to diagnose HCC. • Exclusion of LR-1/2/M improves specificity when HBP hypointensity is used.
使用肝胆期（HBP）低信号作为洗脱的替代方法，结合其他特征，验证钆塞酸增强磁共振成像（Gd-EOB-MRI）诊断肝细胞癌（HCC）的新诊断标准。
本回顾性研究纳入了 288 例 HCC 高危患者，共 387 个结节（HCC 患者 292 例，非 HCC 患者 95 例），在 Gd-EOB-MRI 上均显示动脉期高增强（APHE）≥1cm。使用不同标准诊断 HCC ：门静脉期（PVP）低信号（标准 1）、PVP 和/或过渡期（TP）低信号（标准 2）、PVP 和/或 TP 和/或 HBP 低信号（标准 3），以及根据 Liver Imaging Reporting and Data System（LI-RADS）v2017 考虑辅助特征的标准 3 加非 LR-1/2/M（标准 4）。采用 McNemar 检验比较这些标准的敏感性和特异性。
在 HCC 诊断标准中，标准 3 和 4 的敏感性（分别为 93.8%和 92.5%）显著高于标准 1 和 2（分别为 70.9%和 86.6%）（p 值<0.001）。标准 4 的特异性（87.4%）显著高于标准 3（48.4%）（p<0.001），但与标准 2（86.3%）相当，显著低于标准 1（97.9%）（p=0.002）。
在 Gd-EOB-MRI 诊断 HCC 时，HBP 低信号可替代洗脱，如果根据特征性影像学特征排除认为是良性或非 HCC 恶性的结节后，HBP 低信号可用于高度敏感诊断，特异性损失较小。
• Gd-EOB-MRI 增强和辅助特征可用于诊断 HCC。
• 排除 LR-1/2/M 可提高 HBP 低信号时的特异性。
