Yang Li, Rao Shengxiang, Jin Kaipu, Wu Lifang, Zeng Mengsu, Ding Ying
Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
BMC Gastroenterol. 2025 Jul 1;25(1):483. doi: 10.1186/s12876-025-04071-y.
To compare the diagnostic performances of washout (WO) criteria confined to portal venous phase (PVP), extended to transition phase (TP) or hepatobiliary phase (HBP) for subcentimeter hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced MRI.
Two hundred patients (mean age, 53.4 ± 10.4 years) who were scanned with 1.5-T gadoxetic acid-enhanced MRI were included. Arterial phase hyperenhancement and signal intensity on PVP, TP and HBP images were evaluated. Three WO criteria were established: WO confined to the PVP, WO extended to the TP and WO extended to the HBP.
Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy with 95% confidence interval were calculated for WO confined to the PVP and WO extended to the TP or HBP, and generalized estimating equation was used to compare sensitivity, specificity, PPV, NPV and accuracy.
A total of 200 surgically confirmed subcentimeter hepatic nodules (171 HCCs and 29 non-HCCs) were included. For solitary subcentimeter HCCs, WO extended to the TP showed significantly higher sensitivity and accuracy than WO confined to the PVP (70.80% vs. 49.64%, P < 0.05; 71.52% vs. 55.70%, P < 0.001) and AFP (70.80% vs. 51.09%, P < 0.05; 71.52% vs. 55.70%, P < 0.05), but no significant difference in specificity (76.19% vs. 95.24%, P > 0.05; 76.19% vs. 85.71%, P > 0.05). Extending WO to the HBP achieved significantly higher sensitivity (78.10% vs. 49.64%, P < 0.001; 78.10% vs. 70.80%, P < 0.05) and accuracy (75.32% vs. 55.70%, P < 0.001; 75.32% vs. 71.52%, P < 0.05) compared to WO confined to the PVP and WO extended to the TP, but lower specificity (57.14%% vs. 95.24%, P < 0.05) compared to WO confined to the PVP. The combination of AFP with WO confined to the PVP, WO extended to the TP, or WO extended to the HBP yielded significantly higher sensitivities and accuracies compared to each MRI washout criterion alone (all P < 0.001).
WO extending to TP rather than HBP may be a preferred alternative for diagnosing subcentimeter HCC, and the supplement of AFP may improve sensitivity and accuracy.
使用钆塞酸二钠增强磁共振成像（MRI）比较局限于门静脉期（PVP）、扩展至门脉-肝实质移行期（TP）或肝胆期（HBP）的廓清（WO）标准对亚厘米级肝细胞癌（HCC）的诊断效能。
纳入200例行1.5-T钆塞酸二钠增强MRI扫描的患者（平均年龄53.4±10.4岁）。评估动脉期高增强以及PVP、TP和HBP图像上的信号强度。建立了三个WO标准：局限于PVP的WO、扩展至TP的WO和扩展至HBP的WO。
计算局限于PVP的WO以及扩展至TP或HBP的WO的敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和95%置信区间的准确度，并使用广义估计方程比较敏感度、特异度、PPV、NPV和准确度。
共纳入200个经手术证实的亚厘米级肝结节（171个HCC和29个非HCC）。对于孤立性亚厘米级HCC，扩展至TP的WO显示出比局限于PVP的WO显著更高的敏感度和准确度（70.80%对49.64%，P<0.05；71.52%对55.70%，P<0.001）以及甲胎蛋白（AFP）（70.80%对51.09%，P<0.05；71.52%对55.70%，P<0.05），但特异度无显著差异（76.19%对95.24%，P>0.05；76.19%对85.71%，P>0.05）。与局限于PVP的WO和扩展至TP的WO相比，扩展至HBP的WO实现了显著更高的敏感度（78.10%对49.64%，P<0.001；78.10%对70.80%，P<0.05）和准确度（75.32%对55.70%，P<0.001；75.32%对71.52%，P<0.05），但与局限于PVP的WO相比特异度较低（57.14%对95.24%，P<0.05）。与单独的每个MRI廓清标准相比，AFP与局限于PVP的WO、扩展至TP的WO或扩展至HBP的WO联合使用产生了显著更高的敏感度和准确度（所有P<0.001）。
扩展至TP而非HBP的WO可能是诊断亚厘米级HCC的首选替代方法，AFP的补充可能提高敏感度和准确度。
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