Hepatocellular carcinoma in liver transplantation candidates: Detection with gadobenate dimeglumine-enhanced MRI
Hepatocellular carcinoma in liver transplantation candidates: Detection with gadobenate dimeglumine-enhanced MRI
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DOI：
10.2214/ajr.07.2565
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发表时间：
2008-08-01
影响因子：
5
通讯作者：
Choi, Byung Ihn
中科院分区：
文献类型：
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作者：
Choi, Seung Hong;Lee, Jeong Min;Choi, Byung Ihn
OBJECTIVE.本研究的目的是回顾性评价动态钆贝酸二甲胺增强MRI与移植物病理相关性在肝移植患者肝细胞癌（HCC）检测中的诊断性能。47例患者（28例男性，19例女性;平均年龄49岁）在初次肝移植前3个月内接受了动态钆贝酸二甲胺增强MRI。在静脉推注剂量为0.1 mmol/kg体重的钆贝葡胺之前（未增强）和之后（肝动脉、门静脉、平衡期和1小时延迟期）进行动态成像。两名没有病理信息的腹部放射科医生独立进行了回顾性图像分析来检测肝癌结节。在每个结节的基础上，计算两个观察者的灵敏度和阳性预测值。同时评价了其诊断HCC的敏感性和特异性。进行Fisher精确检验，以确定直径大于等于1 cm的HCC结节与直径小于1 cm的HCC结节之间是否存在检测差异，并根据病灶大小（>= 1 cm vs < 1 cm）评估假阳性MRI结果的原因差异。27例患者有41例HCC。在HCC检测中，钆贝酸二甲胺增强MRI对观察者1的灵敏度为85%（41例HCC中的35例），阳性预测值为66%（53个读数中的35例），对观察者2的灵敏度为80%（41例HCC中的33例），阳性预测值为65%（52个读数中的34例）。对于这两个观察者，检测直径为1 cm和更大的HCC的灵敏度（91-94%）与检测直径小于1 cm的HCC的灵敏度（29-43%）显著不同（p < 0.05）。非肿瘤性动脉富血管病变在MR图像上直径小于1 cm的病变（80-86%）比直径大于1 cm的病变（0-25%）更常引起假阳性诊断。两个观察者的差异具有统计学显著性（p < 0.05）。在诊断上，钆贝酸二甲胺增强MRI对两种病变的敏感性为87%（20/23例），特异性为79%（19/24例）。动态钆贝酸二甲胺增强MRI检测HCC的敏感性为80-85%，阳性预测值为65-66%。然而，该技术对于检测和表征直径小于1 cm的病变的价值有限。
OBJECTIVE. The purpose of this study was to retrospectively evaluate the diagnostic performance of dynamic gadobenate dimeglumine-enhanced MRI with explant pathologic correlation in the detection of hepatocellular carcinoma (HCC) in patients undergoing liver transplantation.MATERIALS AND METHODS. Forty-seven patients (28 men, 19 women; mean age, 49 years) underwent dynamic gadobenate dimeglumine-enhanced MRI within 3 months before primary liver transplantation. Dynamic imaging was performed before (unenhanced) and after (hepatic arterial, portal venous, equilibrium, and 1-hour delayed phases) IV bolus administration of gadobenate dimeglumine at 0.1 mmol/kg body weight. Retrospective image analysis to detect HCC nodules was performed independently by two abdominal radiologists who had no pathologic information. On a per-nodule basis, the sensitivity and positive predictive value were calculated for the two observers. Sensitivity and specificity in the diagnosis of HCC also were evaluated. Fisher's exact test was performed to determine whether there was a detection difference between HCC nodules 1 cm in diameter or larger and nodules smaller than 1 cm and to evaluate the differences in causes of false-positive MRI findings based on lesion size (>= 1 cm vs < 1 cm).RESULTS. Twenty-seven patients had 41 HCCs. In HCC detection, gadobenate dimeglumine-enhanced MRI had a sensitivity of 85% (35 of 41 HCCs) and a positive predictive value of 66% (35 of 53 readings) for observer 1 and a sensitivity of 80% (33 of 41 HCCs) and a positive predictive value of 65% (34 of 52 readings) for observer 2. For both observers, sensitivity in the detection of HCCs 1 cm in diameter and larger (91-94%) was significantly different (p < 0.05) from that in detection of HCCs smaller than 1 cm (29-43%). Nonneoplastic arterial hypervascular lesions more often caused false-positive diagnoses of lesions smaller than 1 cm in diameter (80-86%) on MR images than of those 1 cm in diameter and larger (0-25%). The difference was statistically significant (p < 0.05) for both observers. In diagnosis, gadobenate dimeglumine-enhanced MRI had a sensitivity of 87% (20 of 23 patients) and a specificity of 79% (19 of 24 patients) for both observers.CONCLUSION. Dynamic gadobenate dimeglumine-enhanced MRI has a sensitivity of 80-85% and a positive predictive value of 65-66% in the detection of HCC. The technique, however, is of limited value for detecting and characterizing lesions smaller than 1 cm in diameter.