Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
Abdom Radiol (NY). 2023 Jul;48(7):2321-2330. doi: 10.1007/s00261-023-03901-5. Epub 2023 Apr 25.
Hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on gadoxetic acid-enhanced MRI (GA-MRI) may be nonmalignant cirrhosis-associated nodules or hepatocellular carcinomas (HCCs). We aimed to characterize HBP hypointense nodules without APHE on GA-MRI by performing contrast-enhanced ultrasound using perfluorobutane (PFB-CEUS).
In this prospective, single-center study, participants at high-risk of HCC having HBP hypointense nodules without APHE at GA-MRI were enrolled. All participants underwent PFB-CEUS; if APHE and late, mild washout or washout in the Kupffer phase were present, the diagnosis of HCC was established according to the v2022 Korean guidelines. The reference standard consisted of histopathology or imaging. The sensitivity, specificity, and positive/negative predictive values of PFB-CEUS for detecting HCC were calculated. Associations between clinical/imaging features and the diagnosis of HCC were evaluated with logistic regression analyses.
In total, 67 participants (age, 67.0 years ± 8.4; 56 men) with 67 HBP hypointense nodules without APHE (median size, 1.5 cm [range, 1.0-3.0 cm]) were included. The prevalence of HCC was 11.9% (8/67). The sensitivity, specificity, and positive and negative predictive values of PFB-CEUS for detecting HCC were 12.5%(1/8), 96.6%(57/59), 33.3%(1/3) and 89.1%(57/64), respectively. Mild-moderate T2 hyperintensity on GA-MRI (odds ratio, 5.756; P = 0.042) and washout in the Kupffer phase on PFB-CEUS (odds ratio, 5.828; P = 0.048) were independently associated with HCC.
Among HBP hypointense nodules without APHE, PFB-CEUS was specific for detecting HCC, which had a low prevalence. Mild-moderate T2 hyperintensity on GA-MRI and washout in the Kupffer phase on PFB-CEUS may be useful to detect HCC in those nodules.
在钆塞酸增强磁共振成像（GA-MRI）上，肝胆期（HBP）低信号结节且无动脉期增强（APHE）可能是非恶性肝硬化相关结节或肝细胞癌（HCC）。我们旨在通过使用全氟丁烷（PFB-CEUS）来对 GA-MRI 上 HBP 低信号且无 APHE 的结节进行特征描述。
在这项前瞻性、单中心研究中，纳入了在 GA-MRI 上具有 HBP 低信号且无 APHE 的 HCC 高危人群。所有参与者均接受 PFB-CEUS 检查；如果存在 APHE 和晚期轻度洗脱或库普弗期洗脱，则根据 2022 年韩国指南诊断为 HCC。参考标准包括组织病理学或影像学。计算 PFB-CEUS 检测 HCC 的敏感性、特异性、阳性/阴性预测值。采用逻辑回归分析评估临床/影像学特征与 HCC 诊断之间的关联。
共有 67 名（年龄 67.0±8.4 岁，男性 56 名）参与者，其 67 个 HBP 低信号且无 APHE 的结节（中位数大小为 1.5cm[范围，1.0-3.0cm]）被纳入研究。HCC 的患病率为 11.9%（8/67）。PFB-CEUS 检测 HCC 的敏感性、特异性、阳性预测值和阴性预测值分别为 12.5%（8/8）、96.6%（57/59）、33.3%（1/3）和 89.1%（57/64）。GA-MRI 上的轻度至中度 T2 高信号（优势比，5.756；P=0.042）和 PFB-CEUS 上的库普弗期洗脱（优势比，5.828；P=0.048）与 HCC 独立相关。
在 HBP 低信号且无 APHE 的结节中，PFB-CEUS 对 HCC 的检测具有特异性，但 HCC 的患病率较低。GA-MRI 上的轻度至中度 T2 高信号和 PFB-CEUS 上的库普弗期洗脱可能有助于检测这些结节中的 HCC。
