Erdim Cagri, Akgun Elife, Guzelbey Tevfik, Yilmaz Gulsah, Turkcanoglu Mehmet Hamza, Dablan Ali, Esen Akkas Burcu, Kilickesmez Ozgur
University of Health Sciences Basaksehir Cam and Sakura City Hospital, Department of Radiology, Istanbul, Turkey.
University of Health Sciences Basaksehir Cam and Sakura City Hospital, Department of Nuclear Medicine, Istanbul, Turkey.
Abdom Radiol (NY). 2025 Mar 17. doi: 10.1007/s00261-025-04875-2.
To evaluate the predictive value of multiphasic magnetic resonance imaging (MRI) in identifying liver tumor perfusion characteristics and to compare it with hepatic artery perfusion scintigraphy findings in patients considered for selective internal radiation therapy (SIRT) with yttrium-90 (Y-90).
This study included 93 patients diagnosed with primary or secondary liver cancer between May 2021 and February 2024, comprising 47 patients (27 M/20F) deemed unsuitable for SIRT and 46 patients (26 M/20F) eligible for SIRT. The relationship between multiphasic MRI and scintigraphy findings in determining perfusion of tumors was analyzed. Predictive performance was evaluated with receiver operating characteristic (ROC) analysis, and the optimal cut-off values were determined using the Youden index.
The SIRT unsuitable group had a lower frequency of intratumoral arterial phase hyperenhancement(APHE) (40.43% vs. 69.57%, p = 0.042), presence of hyperintensity on T2 sequence (72.34% vs. 95.65%, p = 0.026), lower lesion intensity in the portal phase (p = 0.033), and a lower lesion-to-liver intensity ratio in the portal phase (≤ 0.97, p = 0.011). The absence of intratumoral APHE [p = 0.049, AUC (95% CI) = 0.646 (0.508-0.783)] and a lesion-to-liver intensity ratio in the portal phase with a cut-off value of ≤ 0.97 [p = 0.011, AUC (95% CI) = 0.689 (0.564-0.815)] were significant predictors of SIRT unsuitability.
Both the absence of intratumoral APHE and a lower lesion-to-liver intensity ratio in the portal phase were significant predictors of SIRT unsuitability.
评估多期磁共振成像（MRI）在识别肝肿瘤灌注特征方面的预测价值，并将其与钇-90（Y-90）选择性内放射治疗（SIRT）患者的肝动脉灌注闪烁显像结果进行比较。
本研究纳入了2021年5月至2024年2月期间诊断为原发性或继发性肝癌的93例患者，其中47例（27例男性/20例女性）被认为不适合SIRT，46例（26例男性/20例女性）符合SIRT条件。分析了多期MRI与闪烁显像结果在确定肿瘤灌注方面的关系。采用受试者工作特征（ROC）分析评估预测性能，并使用约登指数确定最佳临界值。
不适合SIRT的组肿瘤内动脉期高增强（APHE）的频率较低（40.43%对69.57%，p = 0.042），T2序列上高信号的出现率较低（72.34%对95.65%，p = 0.026），门脉期病变强度较低（p = 0.033），门脉期病变与肝脏强度比更低（≤0.97，p = 0.011）。肿瘤内无APHE [p = 0.049，AUC（95%CI）= 0.646（0.508 - 0.783）]以及门脉期病变与肝脏强度比临界值≤0.97 [p = 0.011，AUC（95%CI）= 0.689（0.564 - 0.815）]是不适合SIRT的显著预测因素。
肿瘤内无APHE以及门脉期较低的病变与肝脏强度比均是不适合SIRT的显著预测因素。
