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.
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.
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.
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.
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.
• 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.
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。
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。
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。
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。
在 HCC 复发风险患者中，使用钆塞酸肝脏 MRI 和 DWI 可能有助于区分非特异性新动脉期强化病灶与无明确结论的细胞外肝脏 MRI 中早期富血管 HCC 复发。
Gd-EOB-DTPA MRI 肝胆期低信号和 DWI 高信号联合检测对早期富血管 HCC 复发具有高特异性（90.9%）和阳性预测值（95.8%），但敏感性有限。
结合 Gd-EOB-DTPA MRI 肝胆期低信号和 DWI 高信号可以早期诊断富血管型肝细胞癌，并有助于选择患者进行挽救性治疗。
