Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiology, Naval Pohang Hospital, Pohang, South Korea.
Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
Acad Radiol. 2022 Feb;29(2):198-210. doi: 10.1016/j.acra.2020.08.031. Epub 2020 Sep 20.
To perform a systematic review and meta-analysis to determine risk factors for hypervascularization in hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) in patients with hepatocellular carcinoma (HCC).
Pubmed and EMBASE databases were searched up to May 7, 2020. Studies which evaluated radiologic and clinical risk factors for hypervascularization in HBP hypointense nodules without APHE were included. Hazard ratios were meta-analytically pooled using random-effects model. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool.
Sixteen studies with 934 patients were included. HBP hypointense nodules without APHE with baseline size greater than 10 mm, T2 hyperintensity, and restricted diffusion showed risk for hypervascularization with pooled HRs of 2.95 (95% confidence interval [CI], 1.94-4.20), 4.21 (95% CI, 1.15-15.40), 5.83 (95% CI, 1.42-23.95), respectively. Previous HCC history contributed to hypervascularization of the nodules with hazard ratio of 2.06 (95% CI, 1.23-3.44). T1 hyperintensity, intralesional fat, Child-Pugh Class B, sex, alfa-fetoprotein, hepatitis B or C infection were not significant risk factors for hypervascularization (p ≥0.05). Study quality was generally moderate.
HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI with baseline size greater than 10 mm, T2 hyperintensity, restricted diffusion and previous hepatocellular carcinoma history pose higher risk for hypervascularization. Proper patient management in patients with HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI may need to be tailored according to these risk factors.
本研究旨在通过系统回顾和荟萃分析，确定增强磁共振肝胆期（HBP）低信号且动脉期无强化（APHE）的肝细胞癌（HCC）结节内高血管化的危险因素。
检索 Pubmed 和 EMBASE 数据库，检索截至 2020 年 5 月 7 日。纳入评估 HBP 低信号且 APHE 无强化的结节内高血管化的影像学和临床危险因素的研究。使用随机效应模型对风险比进行荟萃分析。使用预后研究质量工具（QUIPS）评估纳入研究的方法学质量。
共纳入 16 项研究，934 例患者。基线直径>10mm、T2 高信号和弥散受限的 HBP 低信号且 APHE 无强化的结节发生高血管化的风险较高，合并 HR 分别为 2.95（95%CI，1.94-4.20）、4.21（95%CI，1.15-15.40）和 5.83（95%CI，1.42-23.95）。既往 HCC 史是结节高血管化的危险因素，风险比为 2.06（95%CI，1.23-3.44）。T1 高信号、瘤内脂肪、Child-Pugh 分级 B、性别、甲胎蛋白、乙型或丙型肝炎感染不是高血管化的危险因素（p≥0.05）。研究质量总体为中等。
增强磁共振肝胆期低信号且动脉期无强化的 HCC 结节，若基线直径>10mm、T2 高信号、弥散受限和既往 HCC 史，提示发生高血管化的风险较高。对于增强磁共振肝胆期低信号且动脉期无强化的 HCC 结节患者，需要根据这些危险因素制定个体化的治疗方案。
