Chan Michael Vinchill, McDonald Stephen J, Ong Yang-Yi, Mastrocostas Katerina, Ho Edwin, Huo Ya Ruth, Santhakumar Cositha, Lee Alice Unah, Yang Jessica
Department of Radiology, Concord Repatriation General Hospital, Sydney, NSW, Australia.
Concord Repatriation General Hospital Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia.
Eur Radiol Exp. 2019 Dec 18;3(1):49. doi: 10.1186/s41747-019-0126-1.
Hepatocellular carcinoma (HCC) guidelines recommend ultrasound screening in high-risk patients. However, in some patients, ultrasound image quality is suboptimal due to factors such as hepatic steatosis, cirrhosis, and confounding lesions. Our aim was to investigate an abbreviated non-contrast magnetic resonance imaging (aNC-MRI) protocol as a potential alternative screening method.
A retrospective study was performed using consecutive liver MRI studies performed over 3 years, with set exclusion criteria. The unenhanced T2-weighted, T1-weighted Dixon, and diffusion-weighted sequences were extracted from MRI studies with a known diagnosis. Each anonymised aNC-MRI study was read by three radiologists who stratified each study into either return to 6 monthly screening or investigate with a full contrast-enhanced MRI study.
A total of 188 patients were assessed; 28 of them had 42 malignant lesions, classified as Liver Imaging Reporting and Data System 4, 5, or M. On a per-patient basis, aNC-MRI had a negative predictive value (NPV) of 97% (95% confidence interval [CI] 95-98%), not significantly different in patients with steatosis (99%, 95% CI 93-100%) and no steatosis (97%, 95% CI 94-98%). Per-patient sensitivity and specificity were 85% (95% CI 75-91%) and 93% (95% CI 90-95%).
Our aNC-MRI HCC screening protocol demonstrated high specificity (93%) and NPV (97%), with a sensitivity (85%) comparable to that of ultrasound and gadoxetic acid contrast-enhanced MRI. This screening method was robust to hepatic steatosis and may be considered an alternative in the case of suboptimal ultrasound image quality.
肝细胞癌（HCC）指南建议对高危患者进行超声筛查。然而，在一些患者中，由于肝脂肪变性、肝硬化和混杂病变等因素，超声图像质量欠佳。我们的目的是研究一种简化的非增强磁共振成像（aNC-MRI）方案作为一种潜在的替代筛查方法。
采用回顾性研究，使用连续3年进行的肝脏MRI研究，并设定排除标准。从未增强的T2加权、T1加权狄克逊和扩散加权序列中提取已知诊断的MRI研究。三位放射科医生对每项匿名的aNC-MRI研究进行解读，将每项研究分为返回每6个月筛查或进行全面的对比增强MRI研究。
共评估了188例患者；其中28例有42个恶性病变，分类为肝脏影像报告和数据系统4、5或M。以患者为基础，aNC-MRI的阴性预测值（NPV）为97%（95%置信区间[CI]95-98%），在有脂肪变性的患者（99%，95%CI 93-100%）和无脂肪变性的患者（97%，95%CI 94-98%）中无显著差异。以患者为基础的敏感性和特异性分别为85%（95%CI 75-91%）和93%（95%CI 90-95%）。
我们的aNC-MRI HCC筛查方案显示出高特异性（93%）和NPV（97%），敏感性（85%）与超声和钆塞酸对比增强MRI相当。这种筛查方法对肝脂肪变性具有较强的耐受性，在超声图像质量欠佳的情况下可被视为一种替代方法。
