Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Eur Radiol. 2021 May;31(5):3315-3325. doi: 10.1007/s00330-020-07438-9. Epub 2020 Nov 7.
To compare the presence of washout and the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) for hepatocellular carcinoma (HCC) according to the presence of hepatic steatosis.
This retrospective study included 566 patients with chronic liver disease who had undergone hepatic resection for hepatic tumors (482 HCCs and 84 non-HCCs) between January 2016 and June 2018 and had available multiphasic CT and MR images. Patients were allocated in the fatty liver (n = 141) or non-fatty liver (n = 425) group according to the presence of hepatic steatosis, defined as lipid droplets in at least 5% of hepatocytes on pathological examination. The presence of HCC washout and the diagnostic performance of CT and MRI for HCC were compared between the groups.
HCC washout was less frequently seen in the fatty liver group than in the non-fatty liver group on CT (61.5% vs. 88.9%, p < 0.001), whereas it was similarly present on MRI in both groups (77.0% vs. 74.4%, p = 0.565). For diagnosis of HCC, the sensitivity (53.3% vs. 80.0%, p < 0.001) and accuracy (53.9% vs. 80.9%, p < 0.001) of CT were lower in the fatty liver group than in the non-fatty liver group. However, for MRI, these values were not significantly different between the groups (p > 0.05).
Hepatic steatosis significantly decreased the performance of CT for the diagnosis of HCC, whereas it did not significantly alter the performance of MRI.
• Unlike MRI, there is vanishing HCC washout on CT caused by the background hepatic steatosis. • The diagnostic performance of CT for the diagnosis of HCC was significantly altered by hepatic steatosis. • The optimal cutoff HU value of the liver parenchyma for the vanishing washout of HCC was < 50 HU on unenhanced CT images.
根据肝脂肪变性的存在，比较计算机断层扫描（CT）和磁共振成像（MRI）在肝细胞癌（HCC）中的洗脱表现和诊断性能。
本回顾性研究纳入了 2016 年 1 月至 2018 年 6 月期间因肝肿瘤（482 例 HCC 和 84 例非 HCC）行肝切除术的 566 例慢性肝病患者，这些患者有 CT 和 MRI 多期扫描图像。根据病理学检查中至少 5%的肝细胞中存在脂滴，将患者分为脂肪肝（n=141）或非脂肪肝（n=425）组。比较两组间 HCC 洗脱的存在和 CT、MRI 对 HCC 的诊断性能。
CT 上，脂肪肝组 HCC 洗脱的检出率低于非脂肪肝组（61.5% vs. 88.9%，p<0.001），而两组在 MRI 上均有类似的存在（77.0% vs. 74.4%，p=0.565）。对于 HCC 的诊断，CT 在脂肪肝组的敏感性（53.3% vs. 80.0%，p<0.001）和准确性（53.9% vs. 80.9%，p<0.001）均低于非脂肪肝组。然而，MRI 两组间无显著差异（p>0.05）。
肝脂肪变性显著降低了 CT 诊断 HCC 的效能，而对 MRI 无明显影响。
与 MRI 不同，由于背景肝脂肪变性，CT 上 HCC 洗脱消失。
肝脂肪变性显著改变了 CT 诊断 HCC 的性能。
用于 HCC 洗脱消失的最佳肝脏 HU 值截断值为平扫 CT 图像上<50 HU。
