Bäumler Wolf, Wiggermann Philipp, Lürken Lukas, Dollinger Marco, Stroszczynski Christian, Beyer Lukas P, Schicho Andreas
Department of Radiology, University Hospital Regensburg, 93042 Regensburg, Germany.
Department of Radiology and Nuclear Medicine, Städtisches Klinikum Braunschweig, 38114 Braunschweig, Germany.
Cancers (Basel). 2021 Mar 30;13(7):1595. doi: 10.3390/cancers13071595.
This single-center retrospective study was conducted to improve the early detection of local tumor progression (LTP) after irreversible electroporation (IRE) of a hepatocellular carcinoma (HCC) using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-based 3T MR imaging and to identify helpful signal characteristics by comparing 23 patients with and 60 patients without LTP. To identify the differences in the sensitivity of MRI sequences, the specificity, positive prediction value, negative prediction value (NPV) and diagnostic odds ratio were calculated. A chi-squared test, two-tailed student's t-test and binary logistic regression model were used to detect distinct patient characteristics and variables for the prediction of LTP. LTP was mostly detected in the peripheral ablation zone (82.6%) within the first six months (87.0%). The central LTP ablation area presented more hypointensities in T1 p.v. (sensitivity: 95.0%; NPV: 90.0%) and in T1 d.p. (sensitivity: 100.0%; NPV: 100.0) while its peripheral part showed more hyperintensities in T2 BLADE (sensitivity: 95.5%; NPV: 80.0%) and in diffusion sequences (sensitivity: 90.0%). Liver cirrhosis seems to be an unfavorable prognosticator for LTP ( = 0.039). In conclusion, LTP mostly occurs in the peripheral ablation zone within six months after IRE. Despite often exhibiting atypical Gd-EOB-DTPA MR signal characteristics, T2 BLADE and diffusion sequences were helpful for their detection in the peripheral zone while T1 p.v. and T1 d.p. had the highest sensitivity in the central zone.
本单中心回顾性研究旨在利用基于钆乙氧基苄基二乙烯三胺五乙酸（Gd-EOB-DTPA）的3T磁共振成像（MRI）改善肝细胞癌（HCC）不可逆电穿孔（IRE）后局部肿瘤进展（LTP）的早期检测，并通过比较23例发生LTP的患者和60例未发生LTP的患者来识别有用的信号特征。为了确定MRI序列敏感性的差异，计算了特异性、阳性预测值、阴性预测值（NPV）和诊断比值比。采用卡方检验、双尾学生t检验和二元逻辑回归模型来检测预测LTP的不同患者特征和变量。LTP大多在头六个月（87.0%）内出现在外周消融区（82.6%）。中央LTP消融区在T1加权像（p.v.）（敏感性：95.0%；NPV：90.0%）和T1延迟期（d.p.）（敏感性：100.0%；NPV：100.0）表现出更多低信号，而其外周部分在T2刀锋序列（BLADE）（敏感性：95.5%；NPV：80.0%）和扩散序列（敏感性：90.0%）表现出更多高信号。肝硬化似乎是LTP的不良预后因素（P = 0.039）。总之，LTP大多发生在IRE后六个月内的外周消融区。尽管LTP常常表现出非典型的Gd-EOB-DTPA MR信号特征，但T2刀锋序列和扩散序列对外周区域LTP的检测有帮助，而T1加权像（p.v.）和T1延迟期（d.p.）在中央区域具有最高敏感性。
