Willemssen François, de Lussanet de la Sablonière Quido, Bos Daniel, IJzermans Jan, De Man Robert, Dwarkasing Roy
Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Cancers (Basel). 2022 Aug 17;14(16):3961. doi: 10.3390/cancers14163961.
To evaluate NC-AMRI for the detection of HCC in high-risk patients.
Patients who underwent yearly contrast-enhanced MRI (i.e., full MRI protocol) of the liver were included retrospectively. For all patients, the sequences that constitute the NC-AMRI protocol, namely diffusion-weighted imaging (DWI), T2-weighted (T2W) imaging with fat saturation, and T1-weighted (T1W) in-phase and opposed-phase imaging, were extracted, anonymized, and uploaded to a separate research server and reviewed independently by three radiologists with different levels of experience. Reader I and III held a mutual training session. Levels of suspicion of HCC per patient were compared and the sensitivity, specificity, and area under the curve (AUC) using the Mann-Whitney U test were calculated. The reference standard was a final diagnosis based on full liver MRI and clinical follow-up information.
Two-hundred-and-fifteen patients were included, 36 (16.7%) had HCC and 179 (83.3%) did not. The level of agreement between readers was reasonable to good and concordant with the level of expertise and participation in a mutual training session. Receiver operating characteristics (ROC) analysis showed relatively high AUC values (range 0.89-0.94). Double reading showed increased sensitivity of 97.2% and specificity of 87.2% compared with individual results (sensitivity 80.1%-91.7%-97.2%; specificity 91.1%-72.1%-82.1%). Only one HCC (2.8%) was missed by all readers.
NC-AMRI presents a good potential surveillance imaging tool for the detection of HCC in high-risk patients. The best results are achieved with two observers after a mutual training session.
评估非对比增强磁共振成像（NC-AMRI）在高危患者中检测肝细胞癌（HCC）的效能。
回顾性纳入每年接受肝脏对比增强磁共振成像（即完整磁共振成像方案）检查的患者。对于所有患者，提取构成NC-AMRI方案的序列，即扩散加权成像（DWI）、脂肪饱和T2加权（T2W）成像以及T1加权（T1W）同相位和反相位成像，进行匿名处理后上传至单独的研究服务器，并由三名经验水平不同的放射科医生独立进行评估。阅片者I和III进行了相互培训。比较每位患者的HCC疑似程度，并使用曼-惠特尼U检验计算敏感性、特异性和曲线下面积（AUC）。参考标准为基于全肝磁共振成像和临床随访信息的最终诊断。
共纳入215例患者，其中36例（16.7%）患有HCC，179例（83.3%）未患HCC。阅片者之间的一致性水平为中等至良好，与专业水平和参与相互培训的情况相符。受试者操作特征（ROC）分析显示AUC值相对较高（范围为0.89 - 0.94）。与单独阅片结果相比，双人阅片显示敏感性提高至97.2%，特异性提高至87.2%（敏感性：80.1% - 91.7% - 97.2%；特异性：91.1% - 72.1% - 82.1%）。所有阅片者仅漏诊1例HCC（2.8%）。
NC-AMRI是一种用于高危患者检测HCC的具有良好潜力的监测成像工具。经过相互培训后由两名观察者进行评估可获得最佳结果。
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