动脉减影在应用钆塞酸增强 MRI 的肝脏成像报告和数据系统（LI-RADS）治疗反应算法中的作用。

Usefulness of Arterial Subtraction in Applying Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Algorithm to Gadoxetic Acid-Enhanced MRI.

机构信息

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.

出版信息

Korean J Radiol. 2021 Aug;22(8):1289-1299. doi: 10.3348/kjr.2020.1394. Epub 2021 May 20.

DOI:10.3348/kjr.2020.1394

PMID:34047507

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8316782/

Abstract

OBJECTIVE

We aimed to evaluate the usefulness of arterial subtraction images for predicting the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) using gadoxetic acid-enhanced MRI and the Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm.

MATERIALS AND METHODS

This study included 90 patients (mean age ± standard deviation, 57 ± 9 years) who underwent liver transplantation or resection after LRT and had 73 viable and 32 nonviable HCCs. All patients underwent gadoxetic acid-enhanced MRI before surgery. Two radiologists assessed the presence of LR-TR features, including arterial phase hyperenhancement (APHE) and LR-TR categories (viable, nonviable, or equivocal), using ordinary arterial-phase and arterial subtraction images. The reference standard for tumor viability was surgical pathology. The sensitivity of APHE for diagnosing viable HCC was compared between ordinary arterial-phase and arterial subtraction images. The sensitivity and specificity of the LR-TR algorithm for diagnosing viable HCC was compared between the use of ordinary arterial-phase and the use of arterial subtraction images. Subgroup analysis was performed on lesions treated with transarterial chemoembolization (TACE) only.

RESULTS

The sensitivity of APHE for viable HCCs was higher for arterial subtraction images than ordinary arterial-phase images (71.2% vs. 47.9%; < 0.001). LR-TR viable category with the use of arterial subtraction images compared with ordinary arterial-phase images showed a significant increase in sensitivity (76.7% [56/73] vs. 63.0% [46/73]; = 0.002) without significant decrease in specificity (90.6% [29/32] vs. 93.8% [30/32]; > 0.999). In a subgroup of 63 lesions treated with TACE only, the use of arterial subtraction images showed a significant increase in sensitivity (81.4% [35/43] vs. 67.4% [29/43]; = 0.031) without significant decrease in specificity (85.0% [17/20] vs. 90.0% [18/20]; > 0.999).

CONCLUSION

Use of arterial subtraction images compared with ordinary arterial-phase images improved the sensitivity while maintaining specificity for diagnosing viable HCC after LRT using gadoxetic acid-enhanced MRI and the LR-TR algorithm.

摘要

目的

本研究旨在使用钆塞酸增强 MRI 和 Liver Imaging Reporting and Data System (LR-TR) 治疗反应算法评估动脉减影图像在预测局部区域治疗 (LRT) 后肝细胞癌 (HCC) 活力中的作用。

材料与方法

本研究纳入了 90 例患者（平均年龄±标准差，57±9 岁），这些患者在 LRT 后接受了肝移植或切除术，其中 73 例 HCC 为存活肿瘤，32 例为非存活肿瘤。所有患者均在术前接受了钆塞酸增强 MRI 检查。两名放射科医生使用普通动脉期和动脉减影图像评估 LR-TR 特征的存在，包括动脉期高增强（APHE）和 LR-TR 类别（存活、非存活或不确定）。肿瘤活力的参考标准为手术病理学。比较普通动脉期和动脉减影图像对诊断存活 HCC 的 APHE 敏感性。比较普通动脉期和动脉减影图像对诊断存活 HCC 的 LR-TR 算法的敏感性和特异性。仅对经动脉化疗栓塞 (TACE) 治疗的病变进行亚组分析。

结果

动脉减影图像对存活 HCC 的 APHE 敏感性高于普通动脉期图像（71.2%比 47.9%；<0.001）。与普通动脉期图像相比，使用动脉减影图像的 LR-TR 存活类别显示出显著增加的敏感性（76.7%[56/73]比 63.0%[46/73]；=0.002），而特异性无显著降低（90.6%[29/32]比 93.8%[30/32]；>0.999）。在仅接受 TACE 治疗的 63 个病变的亚组中，使用动脉减影图像显著增加了敏感性（81.4%[35/43]比 67.4%[29/43]；=0.031），而特异性无显著降低（85.0%[17/20]比 90.0%[18/20]；>0.999）。