Washout of hepatocellular carcinoma on portal venous phase of multidetector computed tomography in a pre-transplant population
Washout of hepatocellular carcinoma on portal venous phase of multidetector computed tomography in a pre-transplant population
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DOI：
10.1111/1754-9485.12347
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发表时间：
2015-12-01
影响因子：
1.6
通讯作者：
McCormack, Samuel
中科院分区：
文献类型：
--
作者：
Kitzing, Yu Xuan;Ng, Bernard H. K.;McCormack, Samuel
摘要：洗脱是肝细胞癌（HCC） CT诊断的重要影像学特征。本研究的主要目的是评估移植人群中使用CT检测hcc门静脉期（PVP）洗脱的患病率和观察者间的差异。第二个目的是评价影响PVP冲蚀检测的因素。方法：移植前60天内行CT肝显像的45例患者病理证实有活肝细胞癌。两名放射科医生回顾性回顾了hcc的图像，包括动脉增强和PVP冲洗的特征。获取临床资料、峰值电压、门静脉高压影像学特征、病灶感兴趣区衰减测量、背景肝实质及门静脉。计算肝脏与病灶的衰减比。进行统计学分析。结果：两位读者在45例患者中发现了50例动脉增强型hcc。在共识中，两位读者确定了60%的hcc的洗脱，观察者间一致（kappa = 0.633）。PVP洗脱与病变面积增大、背景肝实质衰减增大、肝与病变衰减比增大、门静脉衰减增大和乙肝病毒状态相关（P值分别为0.027、0.008、0.014、0.017和0.037）。结论：在我们的移植人群中，60%的高血管性hcc出现门静脉期冲洗。影响PVP冲洗存在的因素包括病变大小以及反映门静脉血流动力学的肝脏和门静脉衰减。
Introduction: Washout is an important diagnostic imaging feature of hepatocellular carcinoma (HCC) on computed tomography (CT). The primary aim of this study is to evaluate the prevalence and the interobserver variation in the detection of portal venous phase (PVP) washout of HCCs using CT in a transplant population. The secondary aim is to evaluate factors influencing the detection of PVP washout.Methods: Forty-five patients who underwent CT liver imaging within the 60 days before transplantation had viable HCCs confirmed on pathology. Two radiologists retrospectively reviewed the images for HCCs including features of arterial enhancement and PVP washout. Clinical data, peak kilovoltage, imaging features of portal hypertension, region of interest attenuation measurements of the individual lesions, background liver parenchyma and portal vein were obtained. Liver to lesion attenuation ratio was also calculated. Statistical analysis was performed.Results: The two readers identified 50 arterially enhancing HCCs in 45 patients. In consensus, the two readers identified washout in 60% of the HCCs with a substantial interobserver agreement (kappa = 0.633). PVP washout was associated with larger lesion size, increased background liver parenchyma attenuation, increased liver to lesion attenuation ratio, increased portal vein attenuation and hepatitis B viral status (P = 0.027, 0.008, 0.014, 0.017 and 0.037 respectively).Conclusion: In our transplant population, portal venous phase washout was seen in 60% of the hypervascular HCCs. Factors influencing the presence of PVP washout include lesion size as well as the liver and portal vein attenuation reflective of the portal haemodynamics.