Diagnostic Per-Patient Accuracy of an Abbreviated Hepatobiliary Phase Gadoxetic Acid-Enhanced MRI for Hepatocellular Carcinoma Surveillance
Diagnostic Per-Patient Accuracy of an Abbreviated Hepatobiliary Phase Gadoxetic Acid-Enhanced MRI for Hepatocellular Carcinoma Surveillance
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DOI：
10.2214/ajr.14.12986
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发表时间：
2015-03-01
影响因子：
5
通讯作者：
Bashir, Mustafa R.
中科院分区：
文献类型：
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作者：
Marks, Robert M.;Ryan, Andrew;Bashir, Mustafa R.
目的。本研究旨在评估简化的钆塞酸增强磁共振成像（MRI）方案对肝细胞癌（HCC）监测的患者个体诊断效能。
材料与方法。一项回顾性研究确定了298例连续的有肝细胞癌风险的患者，这些患者参加了基于钆塞酸增强MRI的肝细胞癌监测项目。对每位患者的首次钆塞酸增强MRI进行分析。为模拟简化方案，两名阅片者独立阅读每位患者的两组图像：第1组包括T1加权20分钟肝胆期图像和T2加权单次激发快速自旋回波（SSFSE）图像；第2组包括扩散加权成像（DWI）以及第1组的图像。根据是否存在至少一个符合预定标准的10mm或更大的结节，将图像组判定为阳性或阴性。使用Cohen's kappa统计量评估一致性。采用综合参考标准来确定每位阅片者每组图像的诊断效能。
结果。两名阅片者对两组图像的一致性均较好（kappa值均为0.72），同一阅片者自身的一致性极佳（kappa值为0.97 - 0.99）。对于第1组图像，阅片者A的敏感度为85.7%，阅片者B为79.6%；阅片者A的特异度为91.2%，阅片者B为95.2%；阅片者A的阴性预测值为97.0%，阅片者B为96.0%。第2组图像的阅片者诊断效能几乎相同，298次检查中只有1次在第2组图像上的评分与第1组不同。
结论。由T2加权SSFSE和钆塞酸增强肝胆期组成的简化MRI方案具有较高的阴性预测值，可能是一种可接受的肝细胞癌监测方法。加入DWI序列并未显著改变简化方案的诊断效能。
OBJECTIVE. The purpose of this study is to evaluate the per-patient diagnostic performance of an abbreviated gadoxetic acid-enhanced MRI protocol for hepatocellular carcinoma (HCC) surveillance.MATERIALS AND METHODS. A retrospective review identified 298 consecutive patients at risk for HCC enrolled in a gadoxetic acid-enhanced MRI-based HCC surveillance program. For each patient, the first gadoxetic acid-enhanced MRI was analyzed. To simulate an abbreviated protocol, two readers independently read two image sets per patient: set 1 consisted of T1-weighted 20-minute hepatobiliary phase and T2-weighted single-shot fast spinecho (SSFSE) images; set 2 included diffusion-weighted imaging (DWI) and images from set 1. Image sets were scored as positive or negative according to the presence of at least one nodule 10 mm or larger that met the predetermined criteria. Agreement was assessed using Cohen kappa statistics. A composite reference standard was used to determine the diagnostic performance of each image set for each reader.RESULTS. Interreader agreement was substantial for both image sets (kappa = 0.72 for both) and intrareader agreement was excellent (kappa = 0.97-0.99). Reader performance for image set 1 was sensitivity of 85.7% for reader A and 79.6% for reader B, specificity of 91.2% for reader A and 95.2% for reader B, and negative predictive value of 97.0% for reader A and 96.0% for reader B. Reader performance for image set 2 was nearly identical, with only one of 298 examinations scored differently on image set 2 compared with set 1.CONCLUSION. An abbreviated MRI protocol consisting of T2-weighted SSFSE and gadoxetic acid-enhanced hepatobiliary phase has high negative predictive value and may be an acceptable method for HCC surveillance. The inclusion of a DWI sequence did not significantly alter the diagnostic performance of the abbreviated protocol.