Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2021 Sep 13;16(9):e0257308. doi: 10.1371/journal.pone.0257308. eCollection 2021.
Herein, we assessed whether hepatobiliary phase (HBP) signal intensity (SI) can be used to differentiate HCC and non-HCC malignancies within LR-M observations. 106 LR-M patients based on LI-RADS v2018 who underwent gadoxetate-disodium magnetic resonance imaging and surgery from January 2009 to December 2018 were included. SI of LR-M observation on HBP was analyzed by two radiologists and categorized into dark, low and iso-to-high groups. Tumor was classified as dark when more than 50% of tumor showed hypointensity compared to spleen, as low when more than 50% of tumor showed hyperintensity compared to spleen but hypointensity compared to liver parenchyma, and as iso-to-high if there was even a focal iso-intensity or hyperintensity compared to liver parenchyma. Analysis of clinicopathological factors and association between imaging and histology was performed. Out of 106 LR-M, 42 (40%) were showed dark, 61 (58%) showed low, and 3 (3%) showed iso-to-high SI in HBP. Three iso-to-high SI LR-M were HCCs (P = 0.060) and their major histologic differentiation was Edmondson grade 1 (P = 0.001). 43 out of 61 (71%) low SI LR-M were iCCA or cHCC-CCA (P = 0.002). Inter-reader agreement of HBP SI classification was excellent, with a kappa coefficient of 0.872. LR-M with iso-to-high SI in HBP is prone to being HCC while LR-M with low SI in HBP is prone to being tumor with fibrous stroma such as iCCA and cHCC-CCA. Classification of LR-M based on HBP SI may be a helpful method of differentiating HCC from non-HCC malignancies.
在此，我们评估了肝胆期（HBP）信号强度（SI）是否可用于区分 LR-M 观察中的 HCC 和非 HCC 恶性肿瘤。纳入了 2009 年 1 月至 2018 年 12 月期间根据 LI-RADS v2018 接受钆塞酸二钠磁共振成像和手术的 106 例 LR-M 患者。由两位放射科医生分析 LR-M 观察在 HBP 上的 SI，并将其分为暗、低和等至高组。当与脾脏相比，肿瘤超过 50%的区域显示为低信号强度时，肿瘤被归类为暗；当与脾脏相比，肿瘤超过 50%的区域显示为高信号强度，但与肝实质相比显示为低信号强度时，肿瘤被归类为低；当与肝实质相比存在局灶性等信号强度或高信号强度时，肿瘤被归类为等至高。对临床病理因素和影像学与组织学之间的关联进行了分析。在 106 例 LR-M 中，42 例（40%）显示 HBP 为暗，61 例（58%）显示低，3 例（3%）显示等至高 SI。3 例等至高 SI 的 LR-M 为 HCC（P = 0.060），其主要组织学分化为 Edmondson 分级 1（P = 0.001）。61 例低 SI 的 LR-M 中，43 例（71%）为 iCCA 或 cHCC-CCA（P = 0.002）。HBP SI 分类的两位观察者之间的一致性极好，kappa 系数为 0.872。HBP 呈等至高 SI 的 LR-M 倾向于 HCC，而 HBP 呈低 SI 的 LR-M 倾向于纤维基质肿瘤，如 iCCA 和 cHCC-CCA。基于 HBP SI 的 LR-M 分类可能是区分 HCC 和非 HCC 恶性肿瘤的一种有用方法。
