Hepatospecific MR contrast agent uptake on hepatobiliary phase can be used as a biomarker of marked β-catenin activation in hepatocellular adenoma
Hepatospecific MR contrast agent uptake on hepatobiliary phase can be used as a biomarker of marked β-catenin activation in hepatocellular adenoma
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DOI：
10.1007/s00330-020-07434-z
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发表时间：
2020-11-04
影响因子：
5.9
通讯作者：
Luciani，A.
中科院分区：
文献类型：
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作者：
Reizine，E.;Ronot，M.;Luciani，A.
目的探讨肝特异性MR造影剂摄取在肝胆期（HBP）图像上检测肝细胞腺瘤（HCAs）中β-catenin通路显著激活的价值。方法：这项经irb批准的多中心回顾性研究纳入了所有经病理证实的HCA患者，这些患者接受了加苯二胺增强的HBP肝脏MRI检查。首先目视评估HBP上的肿瘤信号强度，并根据与肝脏的相对信号强度将病变分为三组：低信号、等信号或高信号。然后使用病变与肝脏对比增强比（LLCER）定量摄取。最后，对HBP分析描述HCA中标记β-catenin活化的准确性进行了评估。结果共分析了124个HCAs，其中12个具有显著的β-catenin活化（hcab +）。目视分析将94/124（76%）、12/124（10%）和18/124 (14%)hca分别归类为HBP低、等、高。其中HCA B+分别为1/94（1%）、3/12（25%）和8/18 (44%)（p< 0.001）。在整个队列中，HCA B+的LLCER高于未显着β-catenin激活的HCA（平均分别为4.9±11.8%和- 19.8±11.4%,p< 0.001）。LLCER阳性，即LLCER≥0%，诊断HCA B+的敏感性为75% (95% CI 43-95%)，特异性为97% (95% CI 92-99%)， LR+为28 （95% CI 8.8-89.6）。结论肝胆道期特异性对比剂摄取与肝细胞腺瘤β-catenin通路的显著激活密切相关，其应用可能改善肝细胞腺瘤的MRI分型。•肝细胞腺瘤中β-catenin激活的特异性在目视和定量分析中均高于90%。•然而，由于HBP上有大量信号高的hca，特别是那些发生在潜在的肝脂肪变性的hca，单独的目视分析的敏感性不如LLCER量化HBP。
ObjectivesTo assess the value of hepatospecific MR contrast agent uptake on hepatobiliary phase (HBP) images to detect marked activation of the β-catenin pathway in hepatocellular adenomas (HCAs).MethodsThis multicentric retrospective IRB-approved study included all patients with a pathologically proven HCA who underwent gadobenate dimeglumine–enhanced liver MRI with HBP. Tumor signal intensity on HBP was first assessed visually, and lesions were classified into three distinct groups—hypointense, isointense, or hyperintense—according to the relative signal intensity to liver. Uptake was then quantified using the lesion-to-liver contrast enhancement ratio (LLCER). Finally, the accuracy of HBP analysis in depicting marked β-catenin activation in HCA was evaluated.ResultsA total of 124 HCAs were analyzed including 12 with marked β-catenin activation (HCA B+). Visual analysis classified 94/124 (76%), 12/124 (10%), and 18/124 (14%) HCAs as being hypointense, isointense, and hyperintense on HBP, respectively. Of these, 1/94 (1%), 3/12 (25%), and 8/18 (44%) were HCA B+, respectively (p< 0.001). The LLCER of HCA B+ was higher than that of HCA without marked β-catenin activation in the entire cohort (means 4.9 ± 11.8% vs. − 19.8 ± 11.4%, respectively,p< 0.001). A positive LLCER, i.e., LLCER ≥ 0%, had 75% (95% CI 43–95%) sensitivity and 97% (95% CI 92–99%) specificity, with a LR+ of 28 (95% CI 8.8–89.6) for the diagnosis of HCA B+.ConclusionsHepatospecific contrast uptake on hepatobiliary phase is strongly associated with marked activation of the β-catenin pathway in hepatocellular adenoma, and its use might improve hepatocellular adenoma subtyping on MRI.Key Points• Tumor uptake on hepatobiliary phase in both the visual and quantitative analyses had a specificity higher than 90% for the detection of marked β-catenin activation in hepatocellular adenoma.• However, the sensitivity of visual analysis alone is inferior to that of LLCER quantification on HBP due to the high number of HCAs with signal hyperintensity on HBP, especially those developed on underlying liver steatosis.