Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Korean J Radiol. 2022 Apr;23(4):389-401. doi: 10.3348/kjr.2021.0407. Epub 2022 Jan 4.
This study aimed to determine a factor for predicting suboptimal image quality of the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI in patients with extrahepatic bile duct (EHD) cancer before MRI examination.
We retrospectively evaluated 259 patients (mean age ± standard deviation: 68.0 ± 8.3 years; 162 male and 97 female) with EHD cancer who underwent gadoxetic acid-enhanced MRI between 2011 and 2017. Patients were divided into a primary analysis set (n = 184) and a validation set (n = 75) based on the diagnosis date of January 2014. Two reviewers assigned the functional liver imaging score (FLIS) to reflect the HBP image quality. The FLIS consists of the sum of three HBP features, each scored on a 0-2 scale: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified into low-FLIS (0-3) or high-FLIS (4-6) groups. Multivariable analysis was performed to determine a predictor of low FLIS using serum biochemical and imaging parameters of cholestasis severity. The optimal cutoff value for predicting low FLIS was obtained using receiver operating characteristic analysis, and validation was performed.
Of the 259 patients, 140 (54.0%) and 119 (46.0%) were classified into the low-FLIS and high-FLIS groups, respectively. In the primary analysis set, total bilirubin was an independent factor associated with low FLIS (adjusted odds ratio per 1-mg/dL increase, 1.62; 95% confidence interval [CI], 1.32-1.98). The optimal cutoff value of total bilirubin for predicting low FLIS was 2.1 mg/dL with a sensitivity of 95.1% (95% CI: 88.9-98.4) and a specificity of 89.0% (95% CI: 80.2-94.9). In the validation set, the total bilirubin cutoff showed a sensitivity of 92.1% (95% CI: 78.6-98.3) and a specificity of 83.8% (95% CI: 68.0-93.8).
Serum total bilirubin before acquisition of gadoxetic acid-enhanced MRI may help predict suboptimal HBP image quality in patients with EHD cancer.
本研究旨在确定一个可预测在接受钆塞酸增强磁共振成像（MRI）检查前，肝外胆管（EHD）癌患者肝胆期（HBP）图像质量不理想的因素。
我们回顾性评估了 2011 年至 2017 年间接受钆塞酸增强 MRI 检查的 259 例 EHD 癌患者（平均年龄±标准差：68.0±8.3 岁；162 例男性，97 例女性）。根据 2014 年 1 月的诊断日期，患者分为主要分析集（n=184）和验证集（n=75）。两名观察者根据 HBP 特征分配功能肝脏成像评分（FLIS）以反映 HBP 图像质量。FLIS 由三个 HBP 特征的总和组成，每个特征的得分均为 0-2 分：肝实质增强、胆汁排泄和门静脉信号强度。患者被分为低-FLIS（0-3）或高-FLIS（4-6）组。采用多变量分析确定与胆汁淤积严重程度相关的血清生化和影像学参数，以确定低 FLIS 的预测因素。采用受试者工作特征分析获得预测低 FLIS 的最佳截断值，并进行验证。
在 259 例患者中，140 例（54.0%）和 119 例（46.0%）患者分别被分为低-FLIS 和高-FLIS 组。在主要分析集中，总胆红素是与低 FLIS 相关的独立因素（每增加 1mg/dL，调整后的优势比为 1.62；95%置信区间[CI]，1.32-1.98）。预测低 FLIS 的总胆红素最佳截断值为 2.1mg/dL，其敏感性为 95.1%（95%CI：88.9-98.4），特异性为 89.0%（95%CI：80.2-94.9）。在验证集中，总胆红素截断值的敏感性为 92.1%（95%CI：78.6-98.3），特异性为 83.8%（95%CI：68.0-93.8）。
在接受钆塞酸增强 MRI 检查前的血清总胆红素可能有助于预测 EHD 癌患者的 HBP 图像质量不理想。
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