增强超声在肝细胞癌非侵入性诊断算法中的二线诊断模式的作用。
Role of Contrast-Enhanced Ultrasound as a Second-Line Diagnostic Modality in Noninvasive Diagnostic Algorithms for Hepatocellular Carcinoma.
机构信息
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
出版信息
Korean J Radiol. 2021 Mar;22(3):354-365. doi: 10.3348/kjr.2020.0973. Epub 2020 Nov 3.
OBJECTIVE
To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations.
MATERIALS AND METHODS
We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar's test.
RESULTS
The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, = 0.06 by EASL; 86.1%, < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, < 0.01; 86.1% vs. 91.1% by KCLA-NCC, = 0.04). There were no false-positive cases for HCC on CEUS.
CONCLUSION
The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.
目的
探讨对比增强超声（CEUS）在风险观察人群中的诊断性能及其作为钆塞酸增强 MRI（Gd-EOB-MRI）后二线成像方式在肝细胞癌（HCC）诊断中的作用。
材料与方法
我们前瞻性地招募了在监测过程中有治疗初治的≥ 1 cm 肝脏局灶性病变（LR-3/4/5/M）的 HCC 风险观察人群，并进行了 Gd-EOB-MRI 检查。共有 103 名患者的 103 个肝脏观察结果（平均大小 28.2 ± 24.5mm；HCC [n = 79]、非 HCC 恶性肿瘤 [n = 15]、良性 [n = 9]；通过病理 [n = 57]或非侵入性方法 [n = 46]诊断）被纳入本研究。这些患者接受了六氟化硫 CEUS 检查。评估 Gd-EOB-MRI 和 CEUS 的动脉期增强（APHE）和洗脱情况。CEUS 中的特征性洗脱定义为造影剂注射后 60 秒轻度洗脱。根据欧洲肝脏研究协会（EASL）和韩国肝癌协会和国家癌症中心（KLCA-NCC）的指南，确定了 Gd-EOB-MRI 和作为 HCC 二线检查方法的 CEUS 的诊断能力。使用 McNemar 检验比较两种成像方式的诊断能力。
结果
CEUS 的敏感性（60.8%）低于 Gd-EOB-MRI（72.2%，EASL 为 0.06；KLCA-NCC 为 86.1%，< 0.01）；然而，特异性为 100%。在 Gd-EOB-MRI 中对不确定的观察结果进行 CEUS 检查，在 Gd-EOB-MRI 上无 APHE（n = 10）或洗脱（n = 12）的 HCC 进一步在 CEUS 上呈现 APHE（80.0%，8/10）或特征性洗脱（66.7%，8/12），并且比单独使用 Gd-EOB-MRI 诊断出更多的 HCC（EASL 敏感性：72.2% vs. 83.5%，< 0.01；KLCA-NCC 敏感性：86.1% vs. 91.1%，= 0.04）。CEUS 对 HCC 没有假阳性病例。
结论
在 Gd-EOB-MRI 中增加 CEUS 作为二线诊断方法，在不改变特异性的情况下增加 HCC 诊断的频率。
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