Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
7T Magnetic Resonance Imaging Translational Medical Center, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
J Magn Reson Imaging. 2024 Jun;59(6):2071-2081. doi: 10.1002/jmri.29052. Epub 2023 Oct 15.
Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is highly aggressive. Comparing the diagnosis ability of CT and gadoxetate disodium (Gd-EOB-DTPA) MRI for MTM-HCC are lacking.
To compare the performance of Gd-EOB-DTPA MRI and CT for differentiating MTM-HCC from non-MTM-HCC, and determine the prognostic indicator.
Retrospective.
Post-surgery HCC patients, divided into the training (N = 272) and external validation (N = 44) cohorts.
FIELD STRENGTH/SEQUENCE: 3.0 T, T1-weighted imaging, in-opp phase, and T1-weighted volumetric interpolated breath-hold examination/liver acquisition with volume acceleration; enhanced CT.
Three radiologists evaluated clinical characteristics (sex, age, liver disease, liver function, blood routine, alpha-fetoprotein [AFP] and prothrombin time international normalization ratio [PT-INR]) and imaging features (tumor length, intratumor fat, hemorrhage, arterial phase peritumoral enhancement, intratumor necrosis or ischemia, capsule, and peritumoral hepatobiliary phase [HBP] hypointensity). Compared the performance of CT and MRI for diagnosing MTM-HCC. Follow-up occurred every 3-6 months, and nomogram demonstrated the probability of MTM-HCC.
Fisher test, t-test or Wilcoxon rank-sum test, area under the curve (AUC), 95% confidence interval (CI), multivariable logistic regression, Kaplan-Meier curve, and Cox proportional hazards. Significance level: P < 0.05.
Gd-EOB-DTPA MRI (AUC: 0.793; 95% CI, 0.740-0.839) outperformed CT (AUC: 0.747; 95% CI, 0.691-0.797) in the training cohort. The nomogram, incorporating AFP, PT-INR, and MRI features (non-intratumor fat, incomplete capsule, intratumor necrosis or ischemia, and peritumoral HBP hypointensity) demonstrated powerful performance for diagnosing MTM-HCC with an AUC of 0.826 (95% CI, 0.631-1.000) in the external validation cohort. Median follow-up was 347 days (interquartile range [IQR], 606 days) for the training cohort and 222 days (IQR, 441 days) for external validation cohort. Intratumor necrosis or ischemia was an independent indicator for poor prognosis.
Gd-EOB-DTPA MRI might assist in preoperative diagnosis of MTM-HCC, and intratumor necrosis or ischemia was associated with poor prognosis.
4 TECHNICAL EFFICACY: Stage 2.
巨梁型-块状肝细胞癌（MTM-HCC）侵袭性强。缺乏 CT 和钆塞酸二钠（Gd-EOB-DTPA）MRI 对 MTM-HCC 诊断能力的比较研究。
比较 Gd-EOB-DTPA MRI 和 CT 对 MTM-HCC 与非 MTM-HCC 的鉴别诊断效能，并确定预后指标。
回顾性。
术后 HCC 患者，分为训练集（N=272）和外部验证集（N=44）。
磁场强度/序列：3.0T，T1 加权成像，同相位，T1 加权容积内插屏气检查/肝脏采集与容积加速；增强 CT。
三位放射科医生评估临床特征（性别、年龄、肝病、肝功能、血常规、甲胎蛋白[AFP]和凝血酶原时间国际标准化比值[PT-INR]）和影像学特征（肿瘤长度、肿瘤内脂肪、出血、动脉期肿瘤周增强、肿瘤内坏死或缺血、包膜和肿瘤周肝胆期[HBP]低信号）。比较 CT 和 MRI 对 MTM-HCC 的诊断性能。随访每 3-6 个月进行一次，列线图显示 MTM-HCC 的概率。
Fisher 检验、t 检验或 Wilcoxon 秩和检验、曲线下面积（AUC）、95%置信区间（CI）、多变量逻辑回归、Kaplan-Meier 曲线和 Cox 比例风险。显著性水平：P<0.05。
在训练集中，Gd-EOB-DTPA MRI（AUC：0.793；95%CI，0.740-0.839）的表现优于 CT（AUC：0.747；95%CI，0.691-0.797）。列线图，纳入 AFP、PT-INR 和 MRI 特征（非肿瘤内脂肪、不完整包膜、肿瘤内坏死或缺血和肿瘤周 HBP 低信号），在外部验证集（AUC：0.826，95%CI，0.631-1.000）中对 MTM-HCC 的诊断具有强大的效能。训练集的中位随访时间为 347 天（四分位距[IQR]，606 天），外部验证集为 222 天（IQR，441 天）。肿瘤内坏死或缺血是预后不良的独立指标。
Gd-EOB-DTPA MRI 可能有助于术前诊断 MTM-HCC，肿瘤内坏死或缺血与预后不良相关。
4 级 技术效果：2 级。
