From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Korea.
Radiology. 2019 Dec;293(3):594-604. doi: 10.1148/radiol.2019190414. Epub 2019 Oct 8.
Background MRI with hepatobiliary contrast material is more sensitive than MRI with extracellular contrast material in the detection of hepatocellular carcinoma (HCC). Purpose To determine whether postsurgical outcomes differ between patients who undergo MRI with hepatobiliary contrast material and those who undergo MRI with extracellular contrast material by analyzing disease-free survival (DFS) rates after curative resection of HCC. Materials and Methods From January 2014 to December 2015, 170 treatment-naïve patients who underwent contrast-enhanced preoperative liver MRI and curative hepatic resection for HCC were retrospectively included and observed until September 2018. DFS rates were compared between the two groups, which were classified based on the type of MRI contrast agent used. The MRI with hepatobiliary contrast material group was further divided into a hypointense nodule-positive group and a hypointense nodule-negative group according to the presence of residual hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) after surgery. DFS rates were calculated by using the Kaplan-Meier method and were compared among the three groups by using a log-rank test. Results Patients were included in either the MRI with extracellular contrast material group ( = 53; mean age, 60 years ± 9 [standard deviation]) or the hepatobiliary contrast material group ( = 117; mean age, 60 years ± 8; 26 patients were in the hypointense nodule-positive group). Over a median follow-up period of 34.1 months, median DFS rates did not differ between the extracellular contrast material group (35.8 months) and the hepatobiliary contrast material group (43.5 months) ( = .46). However, median DFS in the extracellular contrast material group was longer than that in the hypointense nodule-positive group (35.8 months vs 25.8 months, < .001) and shorter than that in the hypointense nodule-negative group (35.8 months vs 48.6 months, .02). Conclusion Patients who undergo preoperative MRI with hepatobiliary contrast material and resection of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement may show better disease-free survival. © RSNA, 2019 See also the editorial by Motosugi in this issue.
背景 与细胞外对比剂相比，肝胆对比磁共振成像（MRI）在检测肝细胞癌（HCC）方面更敏感。目的 通过分析 HCC 根治性切除术后无病生存率（DFS），确定行肝胆对比剂 MRI 与细胞外对比剂 MRI 的患者术后结局是否存在差异。材料与方法 本研究回顾性纳入 2014 年 1 月至 2015 年 12 月期间 170 例接受增强术前肝脏 MRI 且因 HCC 行根治性肝切除术的治疗初治患者，随访至 2018 年 9 月。根据 MRI 对比剂类型将患者分为两组，比较两组的 DFS 率。肝胆对比剂组根据术后是否存在无动脉期高增强的残余肝胆期（HBP）低信号结节进一步分为低信号结节阳性组和低信号结节阴性组。采用 Kaplan-Meier 法计算 DFS 率，并采用对数秩检验比较三组间的 DFS 率。结果 患者被纳入细胞外对比剂组（n = 53；平均年龄，60 岁±9[标准差]）或肝胆对比剂组（n = 117；平均年龄，60 岁±8；26 例为低信号结节阳性组）。中位随访 34.1 个月期间，细胞外对比剂组（35.8 个月）和肝胆对比剂组（43.5 个月）的中位 DFS 率差异无统计学意义（ =.46）。然而，细胞外对比剂组的中位 DFS 长于低信号结节阳性组（35.8 个月比 25.8 个月， <.001），短于低信号结节阴性组（35.8 个月比 48.6 个月， .02）。结论 行术前肝胆对比剂 MRI 且切除无动脉期高增强的 HBP 低信号结节的患者可能具有更好的无病生存率。 ©RSNA，2019 参见本期 Motosugi 编辑述评。
