钆塞酸增强简化MRI用于肝细胞癌监测：初步经验
Gadoxetate-enhanced Abbreviated MRI for Hepatocellular Carcinoma Surveillance: Preliminary Experience.
作者信息
Brunsing Ryan L, Chen Dennis H, Schlein Alexandra, Wolfson Tanya, Gamst Anthony, Mamidipalli Adrija, Vietti Violi Naik, Marks Robert M, Taouli Bachir, Loomba Rohit, Kono Yuko, Sirlin Claude B
机构信息
Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.).
出版信息
Radiol Imaging Cancer. 2019 Nov 29;1(2):e190010. doi: 10.1148/rycan.2019190010. eCollection 2019 Nov.
PURPOSE
To describe a single-center preliminary experience with gadoxetate disodium-enhanced abbreviated MRI for hepatocellular carcinoma (HCC) screening and surveillance in patients with cirrhosis or chronic hepatitis B virus (cHBV).
MATERIALS AND METHODS
This was a retrospective study of consecutive patients aged 18 years and older with cirrhosis or cHBV who underwent at least one gadoxetate-enhanced abbreviated MRI examination for HCC surveillance from 2014 through 2016. Examinations were interpreted prospectively by one of six abdominal radiologists for clinical care. Clinical, imaging, and other data were extracted from electronic medical records. Diagnostic adequacy was assessed in all patients. Diagnostic accuracy was assessed in the subset of patients who could be classified as having HCC or not having HCC on the basis of a composite reference standard.
RESULTS
In this study, 330 patients (93% with cirrhosis; 45% women; mean age, 59 years) underwent gadoxetate-enhanced abbreviated MRI. In the 330 patients, 311 (94.2%) baseline gadoxetate-enhanced abbreviated MRI examinations were diagnostically adequate. Of 141 (43%) of the 330 patients, 91.4% (129 of 141) could be classified as not having HCC and 8.6% (12 of 141) could be classified as having HCC. Baseline gadoxetate-enhanced abbreviated MRI had 0.92 sensitivity (95% confidence interval [CI]: 0.62, 1.00) and 0.91 specificity (95% CI: 0.84, 0.95) for detection of HCC. Of the 330 patients who underwent baseline gadoxetate-enhanced abbreviated MRI, 187 (57%) were lost to follow-up.
CONCLUSION
Gadoxetate-enhanced abbreviated MRI is feasible clinically, has a high diagnostic adequacy rate, and, on the basis of our preliminary experience, accurately depicts HCC in high-risk patients. Strategies to enhance follow-up compliance are needed.© RSNA, 2019 Abdomen/GI, Cirrhosis, Liver, MR-Imaging, Oncology, Screening
目的
描述在肝硬化或慢性乙型肝炎病毒（cHBV）患者中，使用钆塞酸二钠增强的简化MRI进行肝细胞癌（HCC）筛查和监测的单中心初步经验。
材料与方法
这是一项对2014年至2016年期间年龄在18岁及以上、患有肝硬化或cHBV且至少接受过一次钆塞酸增强简化MRI检查以进行HCC监测的连续患者的回顾性研究。检查由六位腹部放射科医生之一进行前瞻性解读以提供临床诊疗。从电子病历中提取临床、影像及其他数据。对所有患者评估诊断充分性。对根据综合参考标准可分类为患有或未患有HCC的患者亚组评估诊断准确性。
结果
本研究中，330例患者（93%患有肝硬化；45%为女性；平均年龄59岁）接受了钆塞酸增强简化MRI检查。在这330例患者中，311例（94.2%）基线钆塞酸增强简化MRI检查诊断充分。在330例患者中的141例（43%）中，91.4%（141例中的129例）可分类为未患有HCC，8.6%（141例中的12例）可分类为患有HCC。基线钆塞酸增强简化MRI检测HCC的敏感性为0.92（95%置信区间[CI]：0.62，1.00），特异性为0.91（95%CI：0.84，0.95）。在接受基线钆塞酸增强简化MRI检查的330例患者中，187例（57%）失访。
结论
钆塞酸增强简化MRI在临床上可行，诊断充分率高，基于我们的初步经验，能准确描绘高危患者中的HCC。需要采取提高随访依从性的策略。©RSNA，2019 腹部/胃肠道、肝硬化、肝脏、磁共振成像、肿瘤学、筛查
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