Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
AJR Am J Roentgenol. 2020 Jan;214(1):81-89. doi: 10.2214/AJR.19.21251. Epub 2019 Oct 1.
The purpose of this article is to compare contrast-enhanced sonography (CEUS) with sulfur hexafluoride with MRI with the liver-specific contrast agent gadobenate dimeglumine in the diagnosis of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) in a cohort of consecutive patients. Patients referred to a tertiary center for hepatobiliary disease who had suspected HCA or FNH on MRI performed with an extracellular gadolinium-based contrast agent underwent a prospective workup including CEUS and MRI with a liver-specific contrast agent. Diagnosis was definite when the findings of CEUS and MRI with a liver-specific contrast agent were concordant; histopathologic examination (HPE) was performed for cases with discordant findings. Descriptive statistics and the association between categoric variables were presented as numbers and percentages and were assessed using the Fisher exact test. The primary analysis was patient based. Sensitivity, specificity, and AUC and predictive values for the diagnosis of HCA and FNH were calculated separately for CEUS and MRI with a liver-specific contrast agent. A total of 181 patients were selected for the first analysis. Findings from CEUS and MRI with a liver-specific contrast agent were concordant for 132 patients (73%) and discordant for 49 (27%). HPE was performed for 26 of the 49 patients with discordant findings (53%), with findings indeterminate for two of these patients, the findings of MRI with a liver-specific contrast agent correct for 21 of the remaining 24 patients (87.5%), and the findings of CEUS correct for three of these 24 patients (12.5%) ( < 0.05). For further analysis, 156 patients with concordant findings or HPE-proven cases were included. For CEUS, the sensitivity and specificity for the diagnosis of HCA and FNH were 85% and 87%, respectively; the ROC AUC value was 0.856; and the positive predictive value and negative predictive value were 79% and 90%, respectively. For MRI with a liver-specific contrast agent, the sensitivity and specificity were 95% each, the ROC AUC value was 0.949, and the positive predictive value and negative predictive value were 92% and 97%, respectively, for the diagnosis of HCA and FNH. The findings of CEUS and MRI with a liver-specific contrast agent showed fair agreement for the diagnosis of HCA and FNH. MRI with a liver-specific contrast agent is diagnostically correct significantly more often than CEUS in cases with discordant findings that are HPE proven.
本文旨在比较对比增强超声（CEUS）与硫六氟化物、MRI 与肝特异性对比剂钆贝葡胺在连续患者队列中诊断肝细胞腺瘤（HCA）和局灶性结节性增生（FNH）的作用。将被转诊至三级肝胆疾病中心、MRI 检查疑诊 HCA 或 FNH 且使用细胞外钆基对比剂进行的患者纳入前瞻性研究，这些患者接受 CEUS 和 MRI 检查，使用肝特异性对比剂。当 CEUS 和 MRI 检查的结果一致时可确诊；当结果不一致时，行组织病理学检查（HPE）。描述性统计和分类变量之间的关系用数字和百分比表示，并使用 Fisher 确切检验进行评估。主要分析基于患者。分别计算 CEUS 和 MRI 检查肝特异性对比剂对 HCA 和 FNH 诊断的灵敏度、特异性、AUC 和预测值。总共对 181 例患者进行了第一次分析。CEUS 和 MRI 检查肝特异性对比剂的结果在 132 例患者（73%）中一致，在 49 例患者（27%）中不一致。对 49 例结果不一致的患者中的 26 例行 HPE（53%），其中 2 例结果不确定，其余 24 例中 21 例（87.5%）MRI 检查肝特异性对比剂的结果正确，24 例中 3 例（12.5%）CEUS 的结果正确（<0.05）。进一步分析时，纳入了 156 例结果一致或 HPE 证实的病例。CEUS 诊断 HCA 和 FNH 的灵敏度和特异性分别为 85%和 87%；ROC AUC 值为 0.856；阳性预测值和阴性预测值分别为 79%和 90%。MRI 检查肝特异性对比剂的灵敏度和特异性均为 95%，ROC AUC 值为 0.949，HCA 和 FNH 的阳性预测值和阴性预测值分别为 92%和 97%。CEUS 和 MRI 检查肝特异性对比剂对 HCA 和 FNH 的诊断具有良好的一致性。在 HPE 证实的不一致结果中，MRI 检查肝特异性对比剂的诊断正确率明显高于 CEUS。
