LI-RADS 类别在钆塞酸增强 MRI 和 18F-FDG PET-CT 对原发性肝癌患者的预后价值。
Prognostic value of LI-RADS category on gadoxetic acid-enhanced MRI and 18F-FDG PET-CT in patients with primary liver carcinomas.
机构信息
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Republic of Korea.
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
Eur Radiol. 2021 Jun;31(6):3649-3660. doi: 10.1007/s00330-020-07378-4. Epub 2020 Nov 19.
OBJECTIVES
To evaluate the postoperative prognostic value of the Liver Imaging Reporting and Data System (LI-RADS) category on gadoxetic acid-enhanced MRI and 18F-fluorodeoxyglucose PET-CT in patients with primary liver carcinomas (PLCs).
METHODS
A total of 189 patients with chronic liver disease and surgically proven single PLC (42 intrahepatic cholangiocarcinomas and 21 combined hepatocellular-cholangiocarcinomas and 126 hepatocellular carcinomas [2:1 matching to non-HCC malignancies]) were retrospectively evaluated with gadoxetic acid-enhanced MRI and PET-CT. Two independent reviewers assigned an LI-RADS category for each observation. The tumor-to-liver standardized uptake value ratio (TLR) was calculated. The overall survival (OS), recurrence-free survival (RFS), and the associated factors were evaluated.
RESULTS
In multivariable analysis, LI-RADS category (LR-4 or LR-5 [LR-4/5] vs. LR-M; OS, hazard ratio [HR] 2.24, p = 0.006; RFS, HR 1.61, p = 0.028) and TLR (low, < 2.3 vs. high, ≥ 2.3; OS, HR 2.09, p = 0.014; RFS, HR 2.17, p < 0.001) were the independent factors for OS and RFS. For the LR-M group, the high TLR group showed lower OS and RFS rates than the low TLR group (OS, p = 0.008; RFS, p < 0.001). For the LR-4/5 group, the OS and RFS rates were not significantly different between the high TLR and low TLR groups (both p > 0.05).
CONCLUSIONS
Both LI-RADS category on MRI and TLR on PET-CT are associated with the postoperative prognosis of PLCs. The prognosis of PLCs classified as LR-M can be further stratified according to the TLR group, but not for the PLCs classified as LR-4/5.
KEY POINTS
• The LI-RADS category (LR-4/5 vs. LR-M) and tumor-to-liver standardized uptake value ratio (TLR, low vs. high) were independent factors for postoperative prognosis of primary liver carcinomas (PLCs). • For PLCs classified as LR-M, the TLR group helps stratify the postoperative prognosis of PLCs, with the high TLR group having a poor prognosis and the low TLR group having a better prognosis (p = 0.008 for OS and p < 0.001 for RFS). • For PLCs classified as LR-4/5, the OS and RFS rates were not significantly different between the high TLR and low TLR groups (both p > 0.05).
目的
评估钆塞酸增强 MRI 和 18F-氟脱氧葡萄糖 PET-CT 中肝脏成像报告和数据系统（LI-RADS）分类对原发性肝癌（PLCs）患者术后预后的预测价值。
方法
回顾性分析了 189 例经手术证实的单发性 PLC 患者（42 例肝内胆管细胞癌、21 例合并肝细胞癌和胆管细胞癌和 126 例肝细胞癌[2：1 与非 HCC 恶性肿瘤匹配]）的慢性肝病患者的资料，这些患者接受了钆塞酸增强 MRI 和 PET-CT 检查。两位独立的审查员为每个观察结果分配了一个 LI-RADS 类别。计算肿瘤与肝脏标准化摄取比值（TLR）。评估总生存期（OS）、无复发生存期（RFS）和相关因素。
结果
多变量分析显示，LI-RADS 类别（LR-4 或 LR-5 [LR-4/5] 与 LR-M；OS，风险比[HR]2.24，p=0.006；RFS，HR1.61，p=0.028）和 TLR（低，<2.3 与高，≥2.3；OS，HR2.09，p=0.014；RFS，HR2.17，p<0.001）是 OS 和 RFS 的独立因素。对于 LR-M 组，高 TLR 组的 OS 和 RFS 率低于低 TLR 组（OS，p=0.008；RFS，p<0.001）。对于 LR-4/5 组，高 TLR 组和低 TLR 组的 OS 和 RFS 率无显著差异（均 p>0.05）。
结论
MRI 上的 LI-RADS 分类和 PET-CT 上的 TLR 均与 PLC 术后预后相关。LR-M 分类的 PLC 可根据 TLR 组进一步分层预后，但对于 LR-4/5 分类的 PLC 则不然。
关键点
LI-RADS 类别（LR-4/5 与 LR-M）和肿瘤与肝脏标准化摄取比值（TLR，低与高）是原发性肝癌（PLCs）术后预后的独立因素。
对于分类为 LR-M 的 PLC，TLR 组有助于分层 PLC 的术后预后，高 TLR 组预后较差，低 TLR 组预后较好（OS 为 p=0.008，RFS 为 p<0.001）。
对于分类为 LR-4/5 的 PLC，高 TLR 组和低 TLR 组之间的 OS 和 RFS 率无显著差异（均 p>0.05）。
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