Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Radiol. 2021 May;22(5):725-734. doi: 10.3348/kjr.2020.1143. Epub 2021 Feb 2.
To intraindividually compare hepatocellular carcinoma (HCC) washout between MRIs using hepatobiliary agent (HBA) and extracellular agent (ECA).
This study included 114 prospectively enrolled patients with chronic liver disease (mean age, 55 ± 9 years; 94 men) who underwent both HBA-MRI and ECA-MRI before surgical resection for HCC between November 2016 and May 2019. For 114 HCCs, the lesion-to-liver visual signal intensity ratio (SIR) using a 5-point scale (-2 to +2) was evaluated in each phase. Washout was defined as negative visual SIR with temporal reduction of visual SIR from the arterial phase. Illusional washout (IW) was defined as a visual SIR of 0 with an enhancing capsule. The frequency of washout and MRI sensitivity for HCC using LR-5 or its modifications were compared between HBA-MRI and ECA-MRI. Subgroup analysis was performed according to lesion size (< 20 mm or ≥ 20 mm).
The frequency of portal venous phase (PP) washout with HBA-MRI was comparable to that of delayed phase (DP) washout with ECA-MRI (77.2% [88/114] vs. 68.4% [78/114]; = 0.134). The frequencies were also comparable when IW was allowed (79.8% [91/114] for HBA-MRI vs. 81.6% [93/114] for ECA-MRI; = 0.845). The sensitivities for HCC of LR-5 (using PP or DP washout) were comparable between HBA-MRI and ECA-MRI (78.1% [89/114] vs. 73.7% [84/114]; = 0.458). In HCCs < 20 mm, the sensitivity of LR-5 was higher on HBA-MRI than on ECA-MRI (70.8% [34/48] vs. 50.0% [24/48]; = 0.034). The sensitivity was similar to each other if IW was added to LR-5 (72.9% [35/48] for HBA-MRI vs. 70.8% [34/48] for ECA-MRI; > 0.999).
Extracellular phase washout for HCC diagnosis was comparable between MRIs with both contrast agents, except for tumors < 20 mm. Adding IW could improve the sensitivity for HCC on ECA-MRI in tumors < 20 mm.
个体内比较使用肝胆对比剂（HBA）和细胞外对比剂（ECA）的 MRI 检测肝细胞癌（HCC）的洗脱情况。
本研究纳入了 2016 年 11 月至 2019 年 5 月期间因 HCC 接受手术切除前接受 HBA-MRI 和 ECA-MRI 的 114 例慢性肝病患者（平均年龄 55 ± 9 岁，94 例男性）。对于 114 个 HCC，在每个阶段使用 5 分制（-2 至+2）评估病变与肝脏的视觉信号强度比（SIR）。洗脱定义为动脉期后视觉 SIR 随时间降低的负性视觉 SIR。假性洗脱（IW）定义为视觉 SIR 为 0 伴增强包膜。比较了 HBA-MRI 和 ECA-MRI 中使用 LR-5 或其改良版的 HCC 洗脱的频率和 MRI 敏感性。根据病变大小（<20mm 或≥20mm）进行亚组分析。
HBA-MRI 门静脉期（PP）洗脱的频率与 ECA-MRI 的延迟期（DP）洗脱相当（77.2%[88/114]与 68.4%[78/114]；=0.134）。当允许 IW 时，频率也相当（HBA-MRI 为 79.8%[91/114]，ECA-MRI 为 81.6%[93/114]；=0.845）。LR-5 对 HCC 的敏感性（使用 PP 或 DP 洗脱）在 HBA-MRI 和 ECA-MRI 之间相当（78.1%[89/114]与 73.7%[84/114]；=0.458）。在<20mm 的 HCC 中，HBA-MRI 上 LR-5 的敏感性高于 ECA-MRI（70.8%[34/48]与 50.0%[24/48]；=0.034）。如果将 IW 添加到 LR-5 中，敏感性彼此相似（HBA-MRI 为 72.9%[35/48]，ECA-MRI 为 70.8%[34/48]；>0.999）。
除了<20mm 的肿瘤外，使用两种对比剂的 MRI 对 HCC 诊断的细胞外洗脱情况相当。在<20mm 的肿瘤中，添加 IW 可以提高 ECA-MRI 对 HCC 的敏感性。
