1 Department of Radiology, Abdominal Imaging Division, University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213.
2 Department of Biopathology and Medical Biotechnologies, Section of Radiology, University Hospital "Paolo Giaccone," Palermo, Italy.
AJR Am J Roentgenol. 2019 Mar;212(3):538-546. doi: 10.2214/AJR.18.20182. Epub 2018 Dec 17.
The objective of our study was to assess the diagnostic performance of texture analysis (TA) on gadoxetic acid-enhanced MR images for differentiation of hepatocellular adenoma (HCA) from focal nodular hyperplasia (FNH).
This study included 40 patients (39 women and one man) with 51 HCAs and 28 patients (27 women and one man) with 32 FNH lesions. All lesions were histologically proven with preoperative MRI performed with gadoxetic acid. Two readers reviewed all the imaging sequences to assess the qualitative MRI characteristics. The T2-weighted fast spin-echo, hepatic arterial phase (HAP), and hepatobiliary phase (HBP) sequences were used for TA. Textural features were extracted using commercially available software (TexRAD). The differences in distributions of TA parameters of FNHs and HCAs were assessed using the Mann-Whitney U test. Area under the ROC curve (AUROC) values were calculated for statistically significant features. A logistic regression analysis was conducted to explore the added value of TA. A p value < 0.002 was considered statistically significant after Bonferroni correction for multiple comparisons.
Multiple TA parameters showed a statistically different distribution in HCA and FNH including skewness on T2-weighted imaging, skewness on HAP imaging, skewness on HBP imaging, and entropy on HBP imaging (p < 0.001). Skewness on HBP imaging showed the largest AUROC (0.869; 95% CI, 0.777-0.933). A skewness value on HBP imaging of greater than -0.06 had a sensitivity of 72.5% and a specificity of 90.6% for the diagnosis of HCA. Six of 51 (11.8%) HCAs lacked hypointensity on HBP imaging. A binary logistic regression analysis including hypointensity on HBP imaging and the statistically significant TA parameters yielded an AUROC of 0.979 for the diagnosis of HCA and correctly predicted 96.4% of the lesions.
TA may be of added value for the diagnosis of atypical HCA presenting without hypointensity on HBP imaging.
本研究旨在评估钆塞酸增强磁共振成像（MRI）纹理分析（TA）在鉴别肝细胞腺瘤（HCA）与局灶性结节增生（FNH）中的诊断性能。
本研究纳入 40 例患者（39 名女性和 1 名男性），共 51 个 HCA 和 28 例患者（27 名女性和 1 名男性），共 32 个 FNH 病变。所有病变均经术前钆塞酸增强 MRI 及组织学证实。两位阅片者均对所有影像学序列进行评估，以分析定性 MRI 特征。使用 T2 加权快速自旋回波、肝动脉期（HAP）和肝胆期（HBP）序列进行 TA。使用商用软件（TexRAD）提取纹理特征。使用 Mann-Whitney U 检验评估 FNH 和 HCA 的 TA 参数分布差异。计算受试者工作特征曲线（ROC）下面积（AUROC）值以评估具有统计学意义的特征。采用逻辑回归分析探索 TA 的附加价值。经 Bonferroni 校正多重比较后，p 值<0.002 认为具有统计学意义。
多个 TA 参数在 HCA 和 FNH 中的分布存在统计学差异，包括 T2 加权成像上的偏度、HAP 成像上的偏度、HBP 成像上的偏度和 HBP 成像上的熵（p<0.001）。HBP 成像上的偏度具有最大的 AUROC（0.869；95%CI，0.777-0.933）。HBP 成像上的偏度值大于-0.06 时，诊断 HCA 的敏感度为 72.5%，特异度为 90.6%。51 个 HCA 中有 6 个（11.8%）在 HBP 成像上无低信号。包括 HBP 成像低信号和具有统计学意义的 TA 参数的二元逻辑回归分析，对 HCA 的诊断 AUROC 为 0.979，正确预测了 96.4%的病变。
TA 对不伴有 HBP 成像低信号的不典型 HCA 的诊断可能具有附加价值。
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