Zhong Xi, Tang Hongsheng, Lu Bingui, You Jia, Piao Jinsong, Yang Peiyu, Li Jiansheng
Department of Radiology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
Front Oncol. 2020 Jan 10;9:1382. doi: 10.3389/fonc.2019.01382. eCollection 2019.
Accurate characterization of small (3 cm) hepatocellular carcinoma (sHCC) and dysplastic nodules (DNs) in cirrhotic liver is challenging. We aimed to investigate whether texture analysis (TA) based on T2-weighted images (T2WI) is superior to qualitative diagnosis using gadoxetic acid-enhanced MR imaging (Gd-EOB-MRI) and diffusion-weighted imaging (DWI) for distinguishing sHCC from DNs in cirrhosis. Sixty-eight patients with 73 liver nodules (46 HCCs, 27 DNs) pathologically confirmed by operation were included. For imaging diagnosis, three sets of images were reviewed by two experienced radiologists in consensus: a Gd-EOB-MRI set, a DWI set, and a combined set (combination of Gd-EOB-MRI and DWI). For TA, 279 texture features resulting from T2WI were extracted for each lesion. The performance of each approach was evaluated by a receiver operating characteristic analysis. The area under the receiver operating characteristic curve ( ), sensitivity, specificity, and accuracy were determined. The performance of TA ( = 0.96) was significantly higher than that of imaging diagnosis using Gd-EOB-MRI set ( = 0.86) or DWI set ( = 0.80) alone in differentiation of sHCC from DNs ( = 0.008 and 0.025, respectively). The combination of Gd-EOB-MRI and DWI showed a greater sensitivity (95.6%) but reduced specificity (66.7%). The specificity of TA (92.6%) was significantly higher than that of the combined set ( < 0.001), but no significant difference was observed in sensitivity (97.8 vs. 95.6%, = 0.559). TA-based T2WI showed a better classification performance than that of qualitative diagnosis using Gd-EOB-MRI and DW imaging in differentiation of sHCCs from DNs in cirrhotic liver. TA-based MRI may become a potential imaging biomarker for the early differentiation HCCs from DNs in cirrhosis.
准确鉴别肝硬化肝脏中的小（3 cm）肝细胞癌（sHCC）和发育异常结节（DN）具有挑战性。我们旨在研究基于T2加权图像（T2WI）的纹理分析（TA）在区分肝硬化中的sHCC与DN方面是否优于使用钆塞酸增强磁共振成像（Gd-EOB-MRI）和扩散加权成像（DWI）的定性诊断。纳入了68例经手术病理证实有73个肝结节（46个HCC、27个DN）的患者。对于影像诊断，由两名经验丰富的放射科医生共同评估三组图像：一组Gd-EOB-MRI图像、一组DWI图像以及一组联合图像（Gd-EOB-MRI和DWI的组合）。对于TA，为每个病变提取由T2WI得出的279个纹理特征。通过受试者工作特征分析评估每种方法的性能。确定受试者工作特征曲线下面积（ ）、敏感性、特异性和准确性。在区分sHCC与DN方面，TA的性能（ = 0.96）显著高于单独使用Gd-EOB-MRI图像组（ = 0.86）或DWI图像组（ = 0.80）的影像诊断（分别为 = 0.008和0.025）。Gd-EOB-MRI和DWI的联合显示出更高的敏感性（95.6%）但特异性降低（66.7%）。TA的特异性（92.6%）显著高于联合图像组（ < 0.001），但在敏感性方面未观察到显著差异（97.8%对95.6%， = 0.559）。在肝硬化肝脏中区分sHCC与DN时，基于TA的T2WI显示出比使用Gd-EOB-MRI和DW成像的定性诊断更好的分类性能。基于TA的MRI可能成为在肝硬化中早期区分HCC与DN的潜在影像生物标志物。
