Shimizu Tatsuya, Motosugi Utaroh, Komatsu Nobutoshi, Ichikawa Shintaro, Inoue Taisuke, Onishi Hiroshi, Enomoto Nobuyuki
Department of Radiology, University of Yamanashi, Yamanashi, Japan.
First Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan.
J Magn Reson Imaging. 2020 Feb;51(2):389-396. doi: 10.1002/jmri.26797. Epub 2019 May 23.
MR-based metrics, including hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE), and liver stiffness as measured by MR elastography are useful markers to stratify the risk of hepatocellular carcinoma (HCC) development in chronic liver disease patients. However, prospective studies are needed to clarify their utility.
To perform a risk analysis of HCC development in chronic liver disease patients, with a focus on MR-based biomarkers.
Prospective.
Consecutive 110 cirrhotic patients (61 males, 49 females) without a history of HCC who matched the inclusion criteria.
FIELD STRENGTH/SEQUENCE: 3T/3D gradient-echo T -weighted images and MR elastography.
Patients underwent MRI for HCC screening and attended follow-up appointments every 3 months. The primary endpoint was the development of hypervascular HCC. Patients were classified according to the presence of an HBP hypointense nodule without APHE (if present in the liver, the patient was classified in nonclean liver group; if absent, clean liver group), and stiffness value on MR elastography (soft liver, <4.0 kPa; stiff liver, ≥4.0 kPa) at the initial examination.
Risk factors were identified in univariate and multivariate Cox regression models. Incidence rates of HCC development were evaluated using the Kaplan-Meier method.
Patients were classified into clean-liver (n = 76) and nonclean-liver groups (n = 34), and into soft-liver (n = 53) and stiff-liver groups (n = 45). During the follow-up period (median, 21.0 months), 16 patients developed hypervascular HCC. Patients in the nonclean-liver group showed a higher incidence of hypervascular HCC than those in the clean-liver group (3-year HCC incidence rates: 50.4% and 5.7%, respectively; P < 0.05). A nonclean liver was independently associated with hypervascular HCC development (hazard ratio, 18.75; 95% confidence interval, 4.83-128.63; P < 0.0001), but stiff liver was not (1.91; 0.66-6.23; P = 0.23).
An HBP hypointense nodule without APHE observed on a gadoxetic acid-enhanced MR image is a strong indicator of subsequent development of hypervascular HCC in patients with chronic liver disease.
2 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:389-396.
基于磁共振成像（MR）的指标，包括肝胆期（HBP）低信号结节且无动脉期高增强（APHE），以及通过MR弹性成像测量的肝脏硬度，是对慢性肝病患者肝细胞癌（HCC）发生风险进行分层的有用标志物。然而，需要前瞻性研究来阐明它们的效用。
对慢性肝病患者的HCC发生风险进行分析，重点关注基于MR的生物标志物。
前瞻性研究。
连续纳入110例符合纳入标准且无HCC病史的肝硬化患者（男性61例，女性49例）。
场强/序列：3T/3D梯度回波T加权成像和MR弹性成像。
患者接受MRI进行HCC筛查，并每3个月进行一次随访。主要终点是发生富血管性HCC。根据初次检查时是否存在无APHE的HBP低信号结节（如果肝脏中存在该结节，则患者被分类为非清洁肝脏组；如果不存在，则为清洁肝脏组）以及MR弹性成像的硬度值（软肝，<4.0 kPa；硬肝，≥4.0 kPa）对患者进行分类。
在单变量和多变量Cox回归模型中确定危险因素。使用Kaplan-Meier方法评估HCC发生的发生率。
患者被分为清洁肝脏组（n = 76）和非清洁肝脏组（n = 34），以及软肝组（n = 53）和硬肝组（n = 45）。在随访期间（中位数为21.0个月），16例患者发生了富血管性HCC。非清洁肝脏组的富血管性HCC发生率高于清洁肝脏组（3年HCC发生率分别为50.4%和5.7%；P < 0.05）。非清洁肝脏与富血管性HCC的发生独立相关（风险比，18.75；95%置信区间，4.83 - 128.63；P < 0.0001），但硬肝则不然（1.91；0.66 - 6.23；P = 0.23）。
在钆塞酸增强MR图像上观察到的无APHE的HBP低信号结节是慢性肝病患者随后发生富血管性HCC的有力指标。
2级 技术效能阶段：5级 《磁共振成像杂志》2020年；51：389 - 396。
