Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Eur J Radiol. 2022 Sep;154:110397. doi: 10.1016/j.ejrad.2022.110397. Epub 2022 Jun 6.
Contrast-enhanced ultrasound (CEUS) and gadoxetate disodium-enhanced MRI (EOB-MRI) may synergize in profiling hepatocellular carcinoma (HCC) aggressiveness considering distinct imaging traits. This study aimed to intra-individually compare CEUS and EOB-MRI with Liver Imaging Reporting and Data System (LI-RADS) in assessing HCC aggressiveness.
From January 2015 to November 2020, consecutive at-risk patients with surgically-confirmed HCC who underwent both preoperative CEUS and EOB-MRI examinations were retrospectively enrolled. Image analyses were conducted independently by two masked radiologists for CEUS and EOB-MRI, respectively. The diagnostic performance of each modality for macrovascular invasion against pathology was evaluated and compared with the McNemar's test, while Edmondson-Steiner grade and the presence of microvascular invasion (MVI) were compared between patients with and without LR-M features on each modality.
A total of 140 patients (mean age, 51.9 years ± 11.0; 116 men) were included. Inter-modality agreement was poor (κ = -0.087 ∼ 0.139) for major LI-RADS features and moderate (κ = 0.449) for overall LI-RADS categorization, and LR-TIV and LR-M were the top sources of inter-modality variations. Although CEUS demonstrated significantly higher specificity for diagnosing macrovascular invasion (96% vs. 89%, P =.02), LR-M features on EOB-MRI were more effective in identifying higher Edmondson-Steiner grades (P =.01) and MVI (P =.02).
Marked discrepancies were found between CEUS and EOB-MRI in evaluating LI-RADS features and categories. Whereas CEUS showed superior diagnostic specificity for macrovascular invasion, LR-M features on EOB-MRI provided more information regarding tumor grade and MVI status in HCC patients.
鉴于不同的影像学特征，对比增强超声（CEUS）和钆塞酸二钠增强磁共振成像（EOB-MRI）可能在评估肝细胞癌（HCC）侵袭性方面具有协同作用。本研究旨在通过个体内比较，评估 CEUS 和 EOB-MRI 联合肝脏成像报告和数据系统（LI-RADS）在评估 HCC 侵袭性方面的作用。
本研究回顾性纳入了 2015 年 1 月至 2020 年 11 月期间连续因 HCC 风险较高而接受术前 CEUS 和 EOB-MRI 检查的手术确诊 HCC 患者。由两位盲法放射科医生分别独立对 CEUS 和 EOB-MRI 进行图像分析。使用 McNemar 检验评估每种检查方法对病理大血管侵犯的诊断性能，并进行比较，同时比较两种检查方法上存在 LR-M 特征的患者与不存在 LR-M 特征的患者之间的 Edmondson-Steiner 分级和微血管侵犯（MVI）的存在情况。
共纳入 140 例患者（平均年龄 51.9±11.0 岁，男性 116 例）。主要 LI-RADS 特征的两种检查方法之间的一致性较差（κ= -0.087∼0.139），而整体 LI-RADS 分类的一致性为中度（κ=0.449），LR-TIV 和 LR-M 是两种检查方法之间差异的主要来源。尽管 CEUS 对诊断大血管侵犯的特异性显著更高（96% vs. 89%，P=.02），但 EOB-MRI 上的 LR-M 特征更能有效识别更高的 Edmondson-Steiner 分级（P=.01）和 MVI（P=.02）。
在评估 LI-RADS 特征和分类方面，CEUS 和 EOB-MRI 之间存在明显差异。虽然 CEUS 对大血管侵犯的诊断特异性较高，但 EOB-MRI 上的 LR-M 特征为 HCC 患者的肿瘤分级和 MVI 状态提供了更多信息。
