在接受经动脉化疗栓塞（TACE）手术的肝硬化患者中，术中双期锥形束计算机断层扫描在检测和表征肝细胞癌（HCC）方面比术前磁共振成像（MRI）和多层螺旋计算机断层扫描（MDCT）具有更高的诊断准确性。
Intra-procedural dual phase cone beam computed tomography has a better diagnostic accuracy over pre-procedural MRI and MDCT in detection and characterization of HCC in cirrhotic patients undergoing TACE procedure.
作者信息
Lucatelli Pierleone, De Rubeis Gianluca, Ginnani Corradini Luca, Basilico Fabrizio, Di Martino Michele, Lai Quirino, Ginanni Corradini Stefano, Cannavale Alessandro, Nardis Pier Giorgio, Corona Mario, Saba Luca, Catalano Carlo, Bezzi Mario
机构信息
Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
出版信息
Eur J Radiol. 2020 Mar;124:108806. doi: 10.1016/j.ejrad.2019.108806. Epub 2019 Dec 24.
PURPOSE
This study was directed to compare diagnostic accuracy of dual-phase cone beam computed tomography (DP-CBCT) vs pre-procedural second line imaging modality (SLIM [multidetector computed tomography and magnetic resonance imaging]) to detect and characterize hepatocellular carcinoma (HCC) in cirrhotic patients with indication for trans-arterial chemoembolization (TACE).
METHODS
This is a single centre, retrospective, and observational study. Exclusion criteria were not-assisted DP-CBCT TACE, and unavailable follow-up SLIM. We evaluated 280 consecutive patients (January/2015-Febraury/2019). Seventy-two patients were eligible. Three radiologists in consensus reviewed: pre-procedural SLIM, DP-CBCT, and SLIM at follow-up, with 4 months of interval between each reading. Hyper-vascular foci (HVF) were detected and characterized. Diameter was recorded. Radiological behaviour, according to LI-RADS criteria, of HFV throughout follow-up time was the reference standard. Diagnostic accuracy was calculated for pre-procedural SLIM and DP-CBCT and evaluated through receiver operating characteristic curve. HVF only visible on DP-CBCT (defined as occult) were analysed. Tumour diameters were compared.
RESULTS
Median time between pre-procedural SLIM and DP-CBCT and between DP-CBCT and definitive radiological diagnosis of HVF were 46.0 days (95%CI 36.5-55.0) and 30.5 days (95%CI 29.0-33.0), respectively. DP-CBCT had a better diagnostic performance than pre-examination SLIM (sensitivity 99%vs78%; specificity 89%vs85%; PPV 99%vs99%; NPV 92%vs30%; and accuracy 94%vs79%). DP-CBCT diagnosed 63 occult HVF. Occult HCC were 54/243 (22.2%). Six were occult angiomas. Three were false positive. Mean diameter was significantly higher in DP-CBCT vs pre-procedural SLIM (+7.5% [95%CI 3.7-11.3], p < 0.05).
CONCLUSIONS
DP-CBCT has a better diagnostic accuracy and NPV than pre-procedural SLIM in cirrhotic patients with indication for TACE.
目的
本研究旨在比较双期锥形束计算机断层扫描（DP-CBCT）与术前二线成像模式（SLIM[多层螺旋计算机断层扫描和磁共振成像]）在检测和表征有经动脉化疗栓塞（TACE）指征的肝硬化患者肝细胞癌（HCC）方面的诊断准确性。
方法
这是一项单中心、回顾性观察研究。排除标准为未辅助的DP-CBCT TACE以及无法获得的随访SLIM。我们评估了280例连续患者（2015年1月至2019年2月）。72例患者符合条件。三位放射科医生进行共识审查：术前SLIM、DP-CBCT以及随访时的SLIM，每次阅片间隔4个月。检测并表征高血管灶（HVF）。记录直径。根据LI-RADS标准，在整个随访期间HVF的放射学表现为参考标准。计算术前SLIM和DP-CBCT的诊断准确性，并通过受试者操作特征曲线进行评估。分析仅在DP-CBCT上可见的HVF（定义为隐匿性）。比较肿瘤直径。
结果
术前SLIM与DP-CBCT之间以及DP-CBCT与HVF最终放射学诊断之间的中位时间分别为46.0天（95%CI 36.5 - 55.0）和30.5天（95%CI 29.0 - 33.0）。DP-CBCT的诊断性能优于术前SLIM（敏感性99%对78%；特异性89%对85%；阳性预测值99%对99%；阴性预测值92%对30%；准确性94%对79%）。DP-CBCT诊断出63个隐匿性HVF。隐匿性HCC为54/243（22.2%）。6个为隐匿性血管瘤。3个为假阳性。DP-CBCT的平均直径显著高于术前SLIM（+7.5%[95%CI 3.7 - 11.3]，p < 0.05）。
结论
对于有TACE指征的肝硬化患者，DP-CBCT比术前SLIM具有更好的诊断准确性和阴性预测值。
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