Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne, 1011, Switzerland.
Eur Radiol. 2020 Dec;30(12):6593-6602. doi: 10.1007/s00330-020-06930-6. Epub 2020 Jun 29.
To compare the diagnostic accuracy of dynamic contrast-enhanced phases, hepatobiliary phase (HBP), and diffusion-weighted imaging (DWI) for the detection of liver metastases from neuroendocrine tumor (NET).
Sixty-seven patients with suspected NET liver metastases underwent gadoxetic acid-enhanced MRI. Three radiologists read four imaging sets separately and independently: DWI, T2W+dynamic, T2WI+HBP, and DWI+HBP. Reference standard included all imaging, histological findings, and clinical data. Sensitivity and specificity were calculated and compared for each imaging set. Interreader agreement was evaluated by intraclass correlation coefficient (ICC). Univariate logistic regression was performed to evaluate lesion characteristics (size, ADC, and enhancing pattern) associated to false positive and negative lesions.
Six hundred twenty-five lesions (545 metastases, 80 benign lesions) were identified. Detection rate was significantly higher combining DWI+HBP than the other imaging sets (sensitivity 86% (95% confidence interval (CI) 0.845-0.878), specificity 94% (95% CI 0.901-0.961)). The sensitivity and specificity of the other sets were 82% and 65% for DWI, 88% and 69% for T2WI, and 90% and 82% for HBP+T2WI, respectively. The interreader agreement was statistically higher for both HBP sets (ICC = 0.96 (95% CI 0.94-0.97) for T2WI+HBP and ICC = 0.91 (95% CI 0.87-0.94) for DWI+HBP, respectively) compared with that for DWI (ICC = 0.76 (95% CI 0.66-0.83)) and T2+dynamic (ICC = 0.85 (95% CI 0.79-0.9)). High ADC values, large lesion size, and hypervascular pattern lowered the risk of false negative.
Given the high diagnostic accuracy of combining DWI+HBP, gadoxetic acid-enhanced MRI is to be considered in NET patients with suspected liver metastases. Fast MRI protocol using T2WI, DWI, and HBP is of interest in this population.
• The combined set of diffusion-weighted (DW) and hepatobiliary phase (HBP) images yields the highest sensitivity and specificity for neuroendocrine liver metastasis (NELM) detection. • Gadoxetic acid should be the contrast agent of choice for liver MRI in NET patients. • The combined set of HBP and DWI sequences could also be used as a tool of abbreviated MRI in follow-up or assessment of treatment such as somatostatin analogs.
比较动态对比增强相、肝胆期（HBP）和弥散加权成像（DWI）在检测神经内分泌肿瘤（NET）肝转移中的诊断准确性。
67 例疑似 NET 肝转移患者接受钆塞酸增强 MRI 检查。三位放射科医生分别独立阅读了四组影像：DWI、T2W+动态、T2WI+HBP 和 DWI+HBP。参考标准包括所有影像学、组织学发现和临床数据。计算并比较了每组影像的敏感性和特异性。采用组内相关系数（ICC）评估读者间的一致性。采用单变量逻辑回归分析与假阳性和假阴性病变相关的病变特征（大小、ADC 和增强模式）。
共检出 625 个病灶（545 个转移灶，80 个良性病灶）。与其他影像组相比，联合 DWI+HBP 的检出率显著更高（敏感性为 86%（95%置信区间 0.845-0.878），特异性为 94%（95%置信区间 0.901-0.961））。其他组的敏感性和特异性分别为 DWI 为 82%和 65%，T2WI 为 88%和 69%，HBP+T2WI 为 90%和 82%。与 DWI 相比，HBP 两组的读者间一致性均具有统计学意义（ICC 分别为 0.96（95%CI 0.94-0.97）和 0.91（95%CI 0.87-0.94）），而与 T2+动态相比（ICC 分别为 0.85（95%CI 0.79-0.9））。高 ADC 值、大病灶大小和血供丰富模式降低了假阴性的风险。
鉴于 DWI+HBP 联合应用具有较高的诊断准确性，在疑似肝转移的 NET 患者中应考虑使用钆塞酸增强 MRI。对于该人群，使用 T2WI、DWI 和 HBP 的快速 MRI 方案具有研究价值。
弥散加权（DW）和肝胆期（HBP）图像的联合应用对神经内分泌肝脏转移（NELM）的检测具有最高的敏感性和特异性。
对于 NET 患者，钆塞酸应为肝脏 MRI 的首选对比剂。
HBP 和 DWI 序列的联合也可以作为随访或评估治疗（如生长抑素类似物）的一种缩短型 MRI 工具。
