BCLC group, Radiology Department, Hospital Clínic Barcelona, Barcelona, Spain.
University of Barcelona, Barcelona, Spain.
Eur Radiol. 2020 Jan;30(1):186-194. doi: 10.1007/s00330-019-06351-0. Epub 2019 Aug 1.
OBJECTIVE: To determine the diagnostic accuracy and predictive value of gadoxetic acid liver MRI (Gd-EOB-DTPA MRI) alone or in combination with diffusion-weighted imaging (DWI) as a second-line tool for detecting early hepatocellular carcinoma (HCC) recurrence in cirrhotic patients with previous HCC treated with resection or ablation. METHODS: Between 2014 and 2017, we prospectively included 34 cirrhotic patients with complete response to resection and/or ablation of early HCC in whom a new focal lesion enhancing in the arterial phase without washout was detected during follow-up with EC-MRI. After signing the informed consent, all patients underwent DWI and Gd-EOB-DTPA MRI; two readers analyzed signal intensities on each phase of dynamic study and on DWI. The final diagnosis was established by histology or follow-up EC-MRI. We used cross-tabulation to calculate indices of diagnostic accuracy. RESULTS: We evaluated 34 patients (7 women; 73.5% with hepatitis C virus) with a total of 53 new arterial-phase-enhancing foci (median size, 10 [IQR 9-14] mm). The final diagnosis, reached by histopathology in 15 (35.7%) lesions and EC-MR follow-up in 27 (64.3%), was HCC in 42 (79.2%) and benign conditions in 11 (21.8%). Hepatobiliary-phase hypointensity on Gd-EOB-DTPA MRI plus hyperintensity on DWI yielded 54.8% sensitivity, 90.9% specificity, 95.8% positive predictive value, and 34.5% negative predictive value for diagnosing HCC recurrence. CONCLUSION: Among potential indices, combining hypointensity on hepatobiliary-phase Gd-EOB-DTPA MRI and hyperintensity on DWI has the highest specificity and positive predictive value to optimally detect HCC recurrence prior to confident diagnosis by conventional imaging criteria on EC-MRI in cirrhotic liver. KEY POINTS: • In patients at risk of HCC recurrence, the use of gadoxetic acid liver MRI and DWI may improve the differentiation of unspecific new arterial-enhancing foci from early hypervascular HCC recurrence in patients with non-conclusive findings on extracellular liver MRI. • Combined findings on hepatobiliary-phase gadoxetic acid-enhanced liver MRI and DWI had high specificity (90.9%) and positive predictive value (95.8%) for detecting early hypervascular HCC recurrence, but limited sensitivity. • Combining hepatobiliary-phase hypointensity on gadoxetic acid MRI and hyperintensity on diffusion-weighted imaging allows early diagnosis of hypervascular hepatocellular carcinoma and may help select patients for salvage therapy.
目的：评估单独或联合使用钆塞酸二钠肝脏 MRI（Gd-EOB-DTPA MRI）联合扩散加权成像（DWI）作为二线工具，用于检测先前接受肝癌切除术或消融术治疗的肝硬化患者中早期 HCC 复发的诊断准确性和预测价值。
方法：2014 年至 2017 年，我们前瞻性纳入了 34 例接受 HCC 切除术或消融术完全缓解的肝硬化患者，这些患者在 EC-MRI 随访期间发现新的局灶性动脉期强化病灶，无洗脱。在签署知情同意书后，所有患者均接受了 DWI 和 Gd-EOB-DTPA MRI 检查；两位观察者分析了动态研究各期和 DWI 的信号强度。最终诊断通过组织学或 EC-MRI 随访确定。我们使用交叉表计算诊断准确性的指标。
结果：我们评估了 34 例患者（7 例女性；73.5%为丙型肝炎病毒感染者）的 53 个新的动脉期强化病灶（中位大小，10 [IQR 9-14]mm）。最终诊断通过组织学检查在 15 个（35.7%）病变中确定，通过 EC-MRI 随访在 27 个（64.3%）病变中确定，其中 42 个（79.2%）为 HCC，11 个（21.8%）为良性病变。Gd-EOB-DTPA MRI 肝胆期低信号加 DWI 高信号对 HCC 复发的诊断具有 54.8%的敏感性、90.9%的特异性、95.8%的阳性预测值和 34.5%的阴性预测值。
结论：在潜在的指标中，结合 Gd-EOB-DTPA MRI 肝胆期低信号和 DWI 高信号具有最高的特异性和阳性预测值，可在肝硬化患者的 EC-MRI 常规成像标准下确诊之前，优化检测 HCC 复发。
关键点：
World J Gastroenterol. 2023-7-28
Hepatol Int. 2023-10
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