Abbreviated Gadoxetic Acid-Enhanced MRI for the Detection of Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Adenocarcinoma
Abbreviated Gadoxetic Acid-Enhanced MRI for the Detection of Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Adenocarcinoma
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DOI：
10.1002/jmri.28059
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发表时间：
2022-01-10
影响因子：
4.4
通讯作者：
Murakami, Takamichi
中科院分区：
文献类型：
--
作者：
Yamaguchi, Takeru;Sofue, Keitaro;Murakami, Takamichi
背景：加多西酸增强磁共振成像(MRI)有助于诊断胰腺导管腺癌(PDAC)的肝转移。然而，较长的检查时间限制了其在PDAC患者初始检查中的应用。目的评价一种简化型伽多沙酸增强MRI在诊断PDAC患者肝转移中的增量价值。研究类型回顾。130例潜在可切除的PDAC患者(女性，58例[44.6%])。场强/序列1.5T和3T；梯度双回波T1加权(同相和反相)、脂肪抑制快速自旋回波T2加权、单次激发回波平面扩散加权和三维脂肪抑制T1加权梯度回波动态对比增强和肝胆相序列，以及对比增强CT(CECT)。评估三位放射科医生独立审查了三组不同的检测肝脏转移的图像：SET 1，单独使用CECT；SET 2，CECT和包括脂肪抑制T2加权、弥散加权和肝胆期图像的简化MRI；以及SET 3，CECT和标准的加多西酸增强MRI。统计检验使用折叠式替代自由反应接收器操作特性比较优值系数(FOM)，并使用McNemar‘s和Fisher’s检验比较每个图像集的其他每个病变和每个患者的诊断参数。P<；0.05被认为具有统计学意义。结果13例患者共发现43个肝转移瘤。SET 2(0.884)和SET 3(0.886)检出肝转移的平均FOM显著高于SET 1(0.609)，而SET 2和SET 3之间相似(P=0.96.SET 2和SET 3的每个患者的平均敏感度、阴性预测值和准确度显著高于SET 1，而SET 2和SET 3之间的灵敏度、阴性预测值和准确度没有显著差异(分别为P>；0.99和P>；0.99)。结论Gadoxtic酸增强MRI联合CECT对PDAC肝转移的诊断价值明显高于CECT。简化MRI和标准MRI的增量值具有可比性。证据水平3技术效能阶段2
Background Gadoxetic acid-enhanced magnetic resonance imaging (MRI) is useful in detecting liver metastases from pancreatic ductal adenocarcinoma (PDAC). However, the long examination time limits its utility in the initial workup of patients with PDAC. Purpose To evaluate the incremental value of an abbreviated gadoxetic acid-enhanced MRI for the detection of liver metastases in patients with PDAC. Study Type Retrospective. Population Patients (N = 130) with potentially resectable PDAC (women, 58 [44.6%]). Field Strength/Sequence 1.5 T and 3 T; gradient dual-echo T1-weighted (in-phase and opposed-phase), fat-suppressed fast spin-echo T2-weighted, single-shot echo-planar diffusion-weighted, and three-dimensional fat-suppressed T1-weighted gradient-echo dynamic contrast-enhanced and hepatobiliary phase sequences, as well as contrast-enhanced computed tomography (CECT). Assessment Three radiologists independently reviewed three different image sets to detect liver metastases: set 1, CECT alone; set 2, CECT and abbreviated MRI comprising fat-suppressed T2-weighted, diffusion-weighted, and hepatobiliary phase images; and set 3, CECT and standard gadoxetic acid-enhanced MRI. Statistical Tests Figure of merit (FOM) was compared using the jackknife alternative free-response receiver operating characteristics, and other per-lesion and per-patient diagnostic parameters for each image set were compared using McNemar's and Fisher's test. P < 0.05 was considered statistically significant. Results A total of 43 liver metastases were identified in 13 patients. Reader-averaged FOM to detect liver metastases were significantly higher for sets 2 (0.884) and 3 (0.886) than for set 1 (0.609), while they were comparable between sets 2 and 3 (P = 0.96). The mean per-patient sensitivities, negative predictive values, and accuracies were significantly higher for sets 2 and 3 than for set 1, while those between sets 2 and 3 were not significantly different (not applicable, P > 0.99, and P > 0.99, respectively). Data Conclusion Gadoxetic acid-enhanced MRI combined with CECT had higher diagnostic performance than CECT alone for the detection of liver metastases in patients with PDAC. The incremental values were comparable for the abbreviated MRI and standard MRI. Level of Evidence 3 Technical Efficacy Stage 2