MRI上的LI-RADS分类与肝内胆管癌术后复发相关：一项多中心研究
LI-RADS Category on MRI Is Associated With Recurrence of Intrahepatic Cholangiocarcinoma After Surgery: A Multicenter Study.
作者信息
Hwang Jeong Ah, Lee Sunyoung, Lee Ji Eun, Yoon Jongjin, Choi Seo-Yeon, Shin Jaeseung
机构信息
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
出版信息
J Magn Reson Imaging. 2023 Mar;57(3):930-938. doi: 10.1002/jmri.28354. Epub 2022 Jul 14.
BACKGROUND
The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing the terminology and interpretation of liver imaging. The association between the LI-RADS category and tumor recurrence in patients with intrahepatic cholangiocarcinomas (iCCAs) has not yet been evaluated in a multicenter study.
PURPOSE
To retrospectively investigate the preoperative clinical and imaging features associated with recurrence-free survival (RFS) after curative resection of iCCAs and to identify the role of the LI-RADS category in at-risk patients.
STUDY TYPE
Retrospective, multicenter.
SUBJECTS
A total of 113 patients (mean age: 61.1 years; 74 men, 39 women) who underwent preoperative contrast-enhanced MRI and curative surgical resection for a single treatment-naive iCCA between 2008 and 2021.
FILED STRENGTH/SEQUENCE: A 3 T dual gradient-echo T WI with in- and opposed-phase, turbo spin-echo T WI, diffusion-weighted echo-planar images, and three-dimensional gradient-echo T WI before and after administration of contrast agent.
ASSESSMENT
MR imaging features were evaluated and assigned for each lesion using LI-RADS version 2018. RFS was calculated from the date of surgery to tumor recurrence or the last imaging date without evidence of recurrence. Factors affecting RFS were evaluated using clinical and imaging features.
STATISTICAL TESTS
Cox proportional hazards model, Kaplan-Meier method, and log-rank test. A P-value of <0.05 was considered statistically significant.
RESULTS
A total of 93 (82.3%) were categorized as LR-M and 20 (17.7%) were categorized as LR-4 or 5. In the multivariable analysis, LR-M category (hazard ratio [HR], 8.035; 95% confidence interval [CI], 1.096-58.931) and a tumor size >3 cm on MRI (HR, 2.690; 95% CI, 1.319-5.487) were independent factors for poor RFS. The 5-year RFS rate was significantly higher in patients with iCCA categorized as LR-4 or 5 than in those categorized as LR-M (94.4% vs. 51.9%, respectively).
DATA CONCLUSION
Patients with iCCA categorized as LR-4 or 5 may have a better RFS than those categorized as LR-M.
EVIDENCE LEVEL
3 TECHNICAL EFFICACY: Stage 2.
背景
肝脏影像报告和数据系统（LI-RADS）是一个用于规范肝脏影像术语和解读的综合系统。肝内胆管癌（iCCA）患者的LI-RADS分类与肿瘤复发之间的关联尚未在多中心研究中得到评估。
目的
回顾性研究iCCA根治性切除术后与无复发生存期（RFS）相关的术前临床和影像特征，并确定LI-RADS分类在高危患者中的作用。
研究类型
回顾性、多中心研究。
研究对象
2008年至2021年间，共有113例患者（平均年龄：61.1岁；男性74例，女性39例）因初治的单发iCCA接受了术前对比增强MRI和根治性手术切除。
场强/序列：3T双梯度回波T1WI同反相位成像、快速自旋回波T2WI、扩散加权回波平面成像以及注射对比剂前后的三维梯度回波T1WI。
评估
使用2018版LI-RADS对每个病灶的MR成像特征进行评估和分类。RFS从手术日期计算至肿瘤复发或无复发证据的最后一次成像日期。使用临床和影像特征评估影响RFS的因素。
统计检验
Cox比例风险模型、Kaplan-Meier法和对数秩检验。P值<0.05被认为具有统计学意义。
结果
共有93例（82.3%）被分类为LR-M，20例（17.7%）被分类为LR-4或5。在多变量分析中，LR-M分类（风险比[HR]，8.035；95%置信区间[CI]，1.096-58.931）和MRI上肿瘤大小>3 cm（HR，2.690；95%CI，1.319-5.487）是RFS不良的独立因素。iCCA分类为LR-4或5的患者5年RFS率显著高于分类为LR-M的患者（分别为94.4%和51.9%）。
数据结论
iCCA分类为LR-4或5的患者可能比分类为LR-M的患者具有更好的RFS。
证据水平
3级 技术效能：2级
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