Diagnosis of LI-RADS M lesions on gadoxetate-enhanced MRI: identifying cholangiocarcinoma-containing tumor with serum markers and imaging features
Diagnosis of LI-RADS M lesions on gadoxetate-enhanced MRI: identifying cholangiocarcinoma-containing tumor with serum markers and imaging features
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钆塞特增强 MRI 诊断 LI-RADS M 病变：通过血清标志物和影像学特征识别含胆管癌的肿瘤
DOI：
10.1007/s00330-020-07488-z
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发表时间：
2020-11-27
影响因子：
5.9
通讯作者：
Bashir, Mustafa R.
中科院分区：
文献类型：
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作者：
Jiang, Hanyu;Song, Bin;Bashir, Mustafa R.
目的LI-RADS M（LR-M）分类描述了可能或肯定为恶性的肝脏病变，但对高危患者的肝细胞癌并不特异。LR-M实体之间的区分，特别是检测含有胆管癌的肿瘤（M-CC），对于治疗和预后至关重要。因此，我们的目的是开发诊断模型钆塞酸二钠增强MRI包括血清肿瘤标志物和LI-RADS成像功能M-CC. MethodsConcretiveat风险患者LR-M病变独家（没有共存LR-4和/或LR-5病变）回顾性检索前瞻性收集的数据库跨越3年。肝内胆管细胞癌（ICC）和肝细胞-胆管细胞联合癌（c-HCC-CCA）一起被归类为M-CC。由三位独立的放射科医生和临床相关的血清肿瘤标志物确定的LI-RADS特征用于通过对组织学的逻辑回归分析生成M-CC诊断模型。每例患者的性能进行了评估，使用的受试者工作曲线（AUC）下的面积，灵敏度和specificity. ResultsForty 5例患者包括，42.2%（19/45）与肝细胞癌，33.3%（15/45）与ICC，13.3%（6/45）与c-HCC-CCA，和11.1%（5/45）与其他肝脏病变。碳水化合物抗原（CA）19-9 > 38 U/mL，甲胎蛋白（AFP）> 4.8 ng/mL，以及缺乏LI-RADS特征“大量血液制品”是M-CC的重要预测因素。结合三个预测因子显示AUC为0.862，灵敏度为76%，特异性为88%。符合所有三个标准的M-CC的风险为98%（AUC，0.690;灵敏度，38%;特异性，100%）.ConclusionsIn高危患者LR-M病变，整合CA 19 -9，AFP，和LI-RADS功能“血液制品质量”实现了M-CC的高诊断性能。当满足所有三个标准时，M-CC的特异性为100%。关键点·在仅有LR-M病变（无LR-4/5病变）的高危患者中，碳水化合物抗原> 38 U/mL、甲胎蛋白> 4. 8 ng/mL且不存在LI-RADS特征“大量血液制品”的模型在诊断含胆管癌的肿瘤方面实现了高准确性。·在满足所有三个标准的患者中，M-CC的特异性为100%，这可能减少或消除活检确认的需要。
ObjectivesThe LI-RADS M (LR-M) category describes hepatic lesions probably or definitely malignant, but not specific for hepatocellular carcinoma in at-risk patients. Differentiation among LR-M entities, particularly detecting cholangiocarcinoma-containing tumors (M-CCs), is essential for treatment and prognosis. Thus, we aimed to develop diagnostic models on gadoxetate disodium–enhanced MRI comprising serum tumor markers and LI-RADS imaging features for M-CC.MethodsConsecutive at-risk patients with LR-M lesions exclusively (no co-existing LR-4 and/or LR-5 lesions) were retrieved retrospectively from a prospectively collected database spanning 3 years. Intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (c-HCC-CCA) were classified together as M-CC. LI-RADS features determined by three independent radiologists and clinically relevant serum tumor markers were used to generate M-CC diagnostic models through logistic regression analysis against histology. Per-patient performance was evaluated using area under the receiver operating curve (AUC), sensitivity, and specificity.ResultsForty-five patients were included, 42.2% (19/45) with hepatocellular carcinoma, 33.3% (15/45) with ICC, 13.3% (6/45) with c-HCC-CCA, and 11.1% (5/45) with other hepatic lesions. Carbohydrate antigen (CA)19-9 > 38 U/mL, α-fetoprotein (AFP) > 4.8 ng/mL, and absence of the LI-RADS feature “blood products in mass” were significant predictors of M-CC. Combining three predictors demonstrated AUC of 0.862, sensitivity of 76%, and specificity of 88%. The risk of M-CC with all three criteria fulfilled was 98% (AUC, 0.690; sensitivity, 38%; specificity, 100%).ConclusionsIn at-risk patients with LR-M lesions, integrating CA19-9, AFP, and the LI-RADS feature “blood products in mass” achieved high diagnostic performance for M-CC. When all three criteria were fulfilled, the specificity for M-CC was 100%.Key Points•In at-risk patients who had LR-M lesions exclusively (no concomitant LR-4/5 lesions), a model with carbohydrate antigen > 38 U/mL, α-fetoprotein > 4.8 ng/mL, and absence of the LI-RADS feature “blood products in mass” achieved high accuracy for diagnosing cholangiocarcinoma-containing tumors.•In patients of whom all three criteria were fulfilled, the specificity for M-CC was 100%, which might reduce or eliminate the need for biopsy confirmation.