Yoon Jeong Hee, Chang Won, Kim Young Kon, Lee Chang Hee, Kim Jeong Woo, Park Beom Jin, Choi Jin-Young, Kim Seung-Seob, Park Hee Sun, Lee Eun Sun, Yu Jeong-Sik, Park Seong Jin, You Myung-Won, Jang Myoung-Jin, Choi Joon-Il, Lee Jeong Min
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Liver Cancer. 2025 Apr 22:1-13. doi: 10.1159/000545965.
Magnetic resonance imaging (MRI) has been shown to outperform computed tomography (CT) in diagnosing hepatocellular carcinoma (HCC), although inconsistencies exist across studies. We compared the performance of CT and gadoxetic acid-enhanced MRI in diagnosing HCC according to various guidelines, and to assess the incremental value of a second-line examination.
This retrospective multicenter study included patients at risk of developing HCC with focal liver lesions (FLLs) ≥10 mm. These patients underwent both contrast-enhanced CT and gadoxetic acid-enhanced MRI between January 2015 and June 2018. Four radiologists independently assessed the images using criteria from the Liver Imaging Reporting and Data System (LI-RADS), the Asian Pacific Association for the Study of the Liver (APASL), and the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) guidelines. The diagnostic performance of CT and MRI was compared across guidelines.
In total, 1,590 FLLs (median size, 22.6 mm) were analyzed in 1,455 patients (median age, 59 years; male, 1,101). Sensitivity was higher with MRI than with CT for APASL (89.3% [95% CI: 87.7%, 90.8%] vs. 78.9% [95% CI: 77.0%, 80.8%], respectively) and KLCA-NCC (78.7% [95% CI: 76.7%, 85.0%] vs. 73.7% [95% CI: 71.6%, 75.7%], respectively) ( = 0.002 for both). However, LI-RADS showed lower sensitivity with MRI than with CT (70.6% [95% CI: 68.4%, 72.6%] vs. 74.7% [95% CI: 72.6%, 76.7%], = 0.002), due to fewer nonperipheral washout. MRI re-categorized 22.4%, 32.2%, and 53.5% of non-HCC observations on CT as HCC with LI-RADS, KLCA-NCC, and APASL, respectively. CT re-classified 30.2%, 29.0%, and 25.8% of non-HCC observations on MRI as HCC with LI-RADS, KLCA-NCC, and APASL, respectively.
The added value of gadoxetic acid-enhanced MRI after CT depends on the diagnostic criteria used. Restricting washout timing to the portal venous phase in LI-RADS reduces the sensitivity of gadoxetic acid-enhanced MRI relative to CT.
磁共振成像（MRI）在诊断肝细胞癌（HCC）方面已被证明优于计算机断层扫描（CT），尽管各研究结果存在不一致。我们根据各种指南比较了CT和钆塞酸增强MRI在诊断HCC方面的性能，并评估二线检查的增量价值。
这项回顾性多中心研究纳入了有发生HCC风险且肝脏局灶性病变（FLLs）≥10 mm的患者。这些患者在2015年1月至2018年6月期间接受了对比增强CT和钆塞酸增强MRI检查。四位放射科医生使用来自肝脏影像报告和数据系统（LI-RADS）、亚太肝脏研究协会（APASL）以及韩国肝癌协会-国家癌症中心（KLCA-NCC）指南的标准独立评估图像。比较了不同指南下CT和MRI的诊断性能。
总共对1455例患者（中位年龄59岁；男性1101例）的1590个FLLs（中位大小22.6 mm）进行了分析。对于APASL，MRI的敏感性高于CT（分别为89.3% [95% CI：87.7%，90.8%] vs. 78.9% [95% CI：77.0%，80.8%]），对于KLCA-NCC也是如此（分别为78.7% [95% CI：76.7%，85.0%] vs. 73.7% [95% CI：71.6%，75.7%]）（两者均P = 0.002）。然而，LI-RADS显示MRI的敏感性低于CT（70.6% [95% CI：68.4%，72.6%] vs. 74.7% [95% CI：72.6%，76.7%]，P = 0.002），原因是外周洗脱较少。MRI分别将CT上22.4%、32.2%和53.5%的非HCC观察结果按照LI-RADS、KLCA-NCC和APASL重新分类为HCC。CT分别将MRI上30.2%、29.0%和25.8%的非HCC观察结果按照LI-RADS、KLCA-NCC和APASL重新分类为HCC。
CT后钆塞酸增强MRI的附加值取决于所使用的诊断标准。在LI-RADS中将洗脱时间限制在门静脉期会降低钆塞酸增强MRI相对于CT的敏感性。
