Bouyer Thomas, Roux Marine, Jacquemin Sarah, Dioguardi Burgio Marco, Sutter Olivier, Laurent-Croisé Valérie, Lonjon Julie, Bricault Ivan, Trillaud Hervé, Rode Agnès, Aubé Christophe, Paisant Anita
Department of Radiology, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France.
Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, 49045 Angers, France.
Diagn Interv Imaging. 2023 Oct;104(10):477-484. doi: 10.1016/j.diii.2023.04.007. Epub 2023 May 19.
The purpose of this study was to compare the detection rate of arterial phase hyperenhancement (APHE) in small hepatocellular carcinoma (HCC) between single arterial phase (single-AP) and triple hepatic arterial (triple-AP) phase MRI and between extracellular (ECA) and hepato-specific (HBA) contrast agents.
A total of 109 cirrhotic patients with 136 HCCs from seven centers were included. There were 93 men and 16 women, with a mean age of 64.0 ± 8.9 (standard deviation) years (range: 42-82 years). Each patient underwent both ECA-MRI and HBA (gadoxetic acid)-MRI examination within one month of each other. Each MRI examination was retrospectively reviewed by two readers blinded to the second MRI examination. The sensitivities of triple- and single-AP for the detection of APHE were compared, and each phase of the triple-AP sequence was compared with the other two.
No differences in APHE detection were found between single-AP (97.2%; 69/71) and triple-AP (98.5%; 64/65) (P > 0.99) at ECA-MRI. No differences in APHE detection were found between single-AP (93%; 66/71) and triple-AP (100%; 65/65) at HBA-MRI (P = 0.12). Patient age, size of the nodules, use of automatic triggering, type of contrast agent, and type of sequence were not significantly associated with APHE detection. The reader was the single variable significantly associated with APHE detection. For triple-AP, best APHE detection rate was found for early and middle-AP images compared to late-AP images (P = 0.001 and P = 0.003). All APHEs were detected with the combination of early-AP and middle-AP images, except one that was detected on late-AP images by one reader.
Our study suggests that both single- and triple-AP can be used in liver MRI for the detection of small HCC especially when using ECA. Early AP and middle-AP are the most efficient phases and should be preferred for detecting APHE, regardless of the contrast agent used.
本研究旨在比较单动脉期（single-AP）和肝动脉三期（triple-AP）磁共振成像（MRI）以及细胞外对比剂（ECA）和肝特异性对比剂（HBA）在小肝细胞癌（HCC）中动脉期高增强（APHE）的检出率。
纳入来自七个中心的109例肝硬化患者，共136个HCC病灶。其中男性93例，女性16例，平均年龄64.0±8.9（标准差）岁（范围：42 - 82岁）。每位患者在一个月内先后接受了ECA-MRI和HBA（钆塞酸）-MRI检查。两位阅片者在不知晓第二次MRI检查结果的情况下对每次MRI检查进行回顾性分析。比较triple-AP和single-AP检测APHE的敏感度，并将triple-AP序列的各期与其他两期进行比较。
在ECA-MRI中，single-AP（97.2%；69/71）和triple-AP（98.5%；64/65）在APHE检测方面无差异（P>0.99）。在HBA-MRI中，single-AP（93%；66/71）和triple-AP（100%；65/65）在APHE检测方面也无差异（P = 0.12）。患者年龄、结节大小、自动触发的使用、对比剂类型和序列类型与APHE检测均无显著相关性。阅片者是与APHE检测显著相关的唯一变量。对于triple-AP，与延迟动脉期图像相比，早期和中期动脉期图像的APHE检出率最高（P = 0.001和P = 0.003）。除一名阅片者在延迟动脉期图像上检测到1个APHE外，所有APHE均通过早期和中期动脉期图像联合检测到。
我们的研究表明，single-AP和triple-AP均可用于肝脏MRI检测小HCC，尤其是使用ECA时。早期动脉期和中期动脉期是检测APHE最有效的时期，无论使用何种对比剂，均应优先选择。
