Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany.
Sci Rep. 2022 Nov 3;12(1):18583. doi: 10.1038/s41598-022-23397-1.
The routine use of dynamic-contrast-enhanced MRI (DCE-MRI) of the liver using hepatocyte-specific contrast agent (HSCA) as the standard of care for the study of focal liver lesions is not widely accepted and opponents invoke the risk of a loss in near 100% specificity of extracellular contrast agents (ECA) and the need for prospective head-to-head comparative studies evaluating the diagnostic performance of both contrast agents. The Purpose of this prospective intraindividual study was to conduct a quantitative and qualitative head-to-head comparison of DCE-MRI using HSCA and ECA in patients with liver cirrhosis and HCC. Twenty-three patients with liver cirrhosis and proven HCC underwent two 3 T-MR examinations, one with ECA (gadoteric acid) and the other with HSCA (gadoxetic acid). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), wash-in, wash-out, image quality, artifacts, lesion conspicuity, and major imaging features of LI-RADS v2018 were evaluated. Wash-in and wash-out were significantly stronger with ECA compared to HSCA (P < 0.001 and 0.006, respectively). During the late arterial phase (LAP), CNR was significantly lower with ECA (P = 0.005), while SNR did not differ significantly (P = 0.39). In qualitative analysis, ECA produced a better overall image quality during the portal venous phase (PVP) and delayed phase (DP) compared to HSCA (P = 0.041 and 0.008), showed less artifacts in the LAP and PVP (P = 0.003 and 0.034) and a higher lesion conspicuity in the LAP and PVP (P = 0.004 and 0.037). There was no significant difference in overall image quality during the LAP (P = 1), in artifacts and lesion conspicuity during the DP (P = 0.078 and 0.073) or in the frequency of the three major LI-RADS v2018 imaging features. In conclusion, ECA provides superior contrast of HCC-especially hypervascular HCC lesions-in DCE-MR in terms of better perceptibility of early enhancement and a stronger washout.
常规使用肝细胞特异性对比剂（HSCA）进行肝脏动态对比增强磁共振成像（DCE-MRI）作为局灶性肝病变研究的标准护理，尚未被广泛接受，反对者认为细胞外对比剂（ECA）的近 100%特异性丧失的风险以及需要前瞻性头对头比较研究来评估两种对比剂的诊断性能。本前瞻性个体内研究的目的是在肝硬化和 HCC 患者中进行使用 HSCA 和 ECA 的 DCE-MRI 的定量和定性头对头比较。23 例肝硬化和经证实的 HCC 患者接受了两次 3T-MR 检查，一次使用 ECA（钆特酸），另一次使用 HSCA（钆塞酸）。评估了信噪比（SNR）、对比噪声比（CNR）、增强、洗脱、图像质量、伪影、病灶显示度和 LI-RADS v2018 的主要成像特征。与 HSCA 相比，ECA 的增强和洗脱明显更强（分别为 P<0.001 和 0.006）。在晚期动脉期（LAP），ECA 的 CNR 明显较低（P=0.005），而 SNR 差异无统计学意义（P=0.39）。在定性分析中，与 HSCA 相比，ECA 在门静脉期（PVP）和延迟期（DP）产生了更好的整体图像质量（P=0.041 和 0.008），在 LAP 和 PVP 中产生的伪影更少（P=0.003 和 0.034），在 LAP 和 PVP 中病灶显示度更高（P=0.004 和 0.037）。在 LAP 期间整体图像质量无显著差异（P=1），在 DP 期间的伪影和病灶显示度无显著差异（P=0.078 和 0.073），LI-RADS v2018 的三种主要成像特征的频率也无显著差异。总之，ECA 在 DCE-MR 中提供了 HCC 的更好对比度-尤其是在超血管 HCC 病变中-在早期增强的可感知性和更强的洗脱方面。
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