Gao Feifei, Wei Yi, Zhang Tong, Jiang Hanyu, Li Qian, Yuan Yuan, Yao Shan, Ye Zheng, Wan Shang, Wei Xiaocheng, Nie Lisha, Tang Hehan, Song Bin
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
MR Research China, GE Healthcare, Beijing, China.
Front Oncol. 2022 Mar 9;12:812832. doi: 10.3389/fonc.2022.812832. eCollection 2022.
Early detection and diagnosis of hepatocellular carcinoma (HCC) is essential for prognosis; however, the imaging hallmarks for tumor detection and diagnosis has remained the same for years despite the use of many new immerging imaging methods. This study aimed to evaluate the detection performance of hepatic nodules in high risk patients using either hepatobiliary specific contrast (HBSC) agent or extracellular contrast agent (ECA), and further to compare the diagnostic performances for hepatocellular carcinoma (HCC) using different diagnostic criteria with the histopathological results as reference standard.
This prospective study included 247 nodules in 222 patients (mean age, 53.32 ± 10.84 years; range, 22-79 years). The detection performance and imaging features of each nodule were evaluated in all MR sequences by three experienced abdominal radiologists. The detection performance of each nodule on all MR sequences were compared and further the diagnostic performance of various diagnostic criteria were evaluated.
For those patients who underwent ECA-MRI, the conventional imaging hallmark of "AP + PVP and/or DP" was recommended, as 60.19% diagnostic sensitivity, 80.95% specificity and 100% lesion detection rate. Additionally, for those patients who underwent HBSC-MRI, the diagnostic criteria of "DWI + HBP" was recommended. This diagnostic criteria demonstrated, both in all tumor size and for nodules ≤2 cm, higher sensitivity (93.07 and 90.16%, all p <0.05, respectively) and slightly lower specificity (64.71 and 87.50%, all p >0.05, respectively) than that of the European Association for the Study of the Liver (EASL) criteria.
Different abbreviated MR protocols were recommended for patients using either ECA or HBSC. These provided imaging settings demonstrated high lesion detection rate and diagnostic performance for HCC.
肝细胞癌（HCC）的早期检测和诊断对预后至关重要；然而，尽管使用了许多新出现的成像方法，但多年来用于肿瘤检测和诊断的影像学特征一直未变。本研究旨在评估使用肝胆特异性对比剂（HBSC）或细胞外对比剂（ECA）对高危患者肝结节的检测性能，并进一步以组织病理学结果为参考标准，比较不同诊断标准对肝细胞癌（HCC）的诊断性能。
本前瞻性研究纳入了222例患者的247个结节（平均年龄53.32±10.84岁；范围22 - 79岁）。由三位经验丰富的腹部放射科医生在所有MR序列中评估每个结节的检测性能和影像特征。比较每个结节在所有MR序列上的检测性能，并进一步评估各种诊断标准的诊断性能。
对于接受ECA - MRI检查的患者，推荐采用“动脉期强化（AP）+门静脉期强化（PVP）和/或延迟期强化（DP）”这一传统影像学特征，其诊断敏感性为60.19%，特异性为80.95%，病变检出率为100%。此外，对于接受HBSC - MRI检查的患者，推荐采用“扩散加权成像（DWI）+肝胆期（HBP）”的诊断标准。该诊断标准在所有肿瘤大小以及直径≤2 cm的结节中，与欧洲肝脏研究协会（EASL）标准相比，均显示出更高的敏感性（分别为93.07%和90.16%，所有p均<0.05）以及略低的特异性（分别为64.71%和87.50%，所有p均>0.05）。
对于使用ECA或HBSC的患者，推荐采用不同的简化MR方案。这些提供的成像设置对HCC显示出较高的病变检出率和诊断性能。
