Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Eur Radiol. 2021 Mar;31(3):1620-1629. doi: 10.1007/s00330-020-07229-2. Epub 2020 Sep 4.
This study aimed to assess the detection of hepatocellular carcinoma (HCC) utilizing subtraction AP (arterial phase) imaging only for T1 hyperintense observations compared with the detection of HCC on subtraction AP imaging that included T1 hyper-, iso-, and hypointense lesions on gadoxetate disodium-enhanced MRI.
This retrospective study included 234 patients (311 observations including 239 HCCs) at high risk for HCC who underwent gadoxetate disodium-enhanced MRI with subtraction AP imaging between 2015 and 2017. Arterial phase hyperenhancement (APHE) was divided into two subtypes: conventional APHE, where subtraction AP imaging is used to detect APHE only for T1 hyperintense observations; and modified APHE, where subtraction AP imaging is applied to T1 hyper-, iso-, and hypointense lesions. Two readers independently reviewed all observations and the per-observation diagnostic performances were compared using McNemar's test.
Modified nonrim APHE showed significantly higher sensitivity than conventional nonrim APHE (90.0% vs 82.8%; p < 0.001) for diagnosing HCC, without a significant difference in specificity (66.7% vs 68.1%; p > 0.999). The LR-5 category with modified nonrim APHE provided better sensitivity than the LR-5 with conventional nonrim APHE (70.3% vs 63.2%; p < 0.001), without a significant decrease in specificity (94.4% vs 95.8%; p > 0.999).
Extended application of subtraction AP imaging for T1 hypo- or isointense observations on gadoxetate disodium-enhanced MRI can improve sensitivity in the diagnosis of HCC without a significant difference in specificity.
• Modified nonrim arterial phase hyperenhancement (APHE), extended application of subtraction arterial phase imaging for T1 hypo- or isointense observation, outperforms conventional nonrim APHE. • The LR-5 category with modified nonrim APHE provided better sensitivity in diagnosing HCC than the LR-5 with conventional APHE, without a significant decrease in specificity.
本研究旨在评估仅利用钆塞酸二钠增强 MRI 的 T1 高信号观察进行动脉期（AP）减影成像（subtraction AP imaging）对肝细胞癌（HCC）的检测，与包括 T1 高、等、低信号病变的 HCC 在动脉期减影成像上的检测进行比较。
本回顾性研究纳入了 2015 年至 2017 年期间接受钆塞酸二钠增强 MRI 并进行动脉期减影成像的 234 例（311 个病灶，包括 239 个 HCC）高危 HCC 患者。动脉期高增强（APHE）分为两种亚型：常规 APHE，即仅对 T1 高信号观察进行动脉期减影成像检测 APHE；改良 APHE，即对 T1 高、等、低信号病变进行动脉期减影成像。两位观察者独立评估所有观察结果，并采用 McNemar 检验比较每个观察结果的诊断性能。
改良非环形 APHE 诊断 HCC 的敏感性显著高于常规非环形 APHE（90.0%比 82.8%；p<0.001），特异性无显著差异（66.7%比 68.1%；p>0.999）。改良非环形 APHE 的 LR-5 类别提供的敏感性优于常规非环形 APHE（70.3%比 63.2%；p<0.001），特异性无显著下降（94.4%比 95.8%；p>0.999）。
在钆塞酸二钠增强 MRI 上对 T1 低或等信号病变的动脉期减影成像进行扩展应用可以提高 HCC 诊断的敏感性，而特异性无显著差异。
• 改良非环形动脉期高增强（APHE），即对钆塞酸二钠增强 MRI 的 T1 低或等信号观察进行动脉期减影成像的扩展应用，优于常规非环形 APHE。• 改良非环形 APHE 的 LR-5 类别在诊断 HCC 时提供了比常规 APHE 的 LR-5 更好的敏感性，而特异性无显著下降。
