Assessment of arterial hypervascularity of hepatocellular carcinoma: comparison of contrast-enhanced US and gadoxetate disodium-enhanced MR imaging
Assessment of arterial hypervascularity of hepatocellular carcinoma: comparison of contrast-enhanced US and gadoxetate disodium-enhanced MR imaging
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DOI：
10.1007/s00330-011-2372-3
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发表时间：
2012-06-01
影响因子：
5.9
通讯作者：
Imai, Yasuharu
中科院分区：
文献类型：
--
作者：
Sugimoto, Katsutoshi;Moriyasu, Fuminori;Imai, Yasuharu
目的以CT肝动脉造影（CTHA）为参考标准，比较超声造影（CE）和钆塞酸盐增强磁共振（MR）成像对肝细胞癌（HCC）和异型增生结节（DN）的诊断价值。所有患者均接受CE超声、钆塞酸二钠增强MRI和CTHA检查。两名训练有素的诊断放射科医生解释CTHA图像，并使用五点置信度作为参考标准，通过共识对肿瘤内动脉血管的程度进行评级。在观察者研究中，由四名独立阅片者使用五点置信度对CE超声和钆塞酸盐二钠增强MR图像上的血管分布程度进行定性分析。结果CE超声诊断乳腺癌的平均ROC曲线下面积（AUC）明显高于CE超声（平均AUC：0.94; 95%置信区间[CI]：0.88-1.00）比钆塞酸二钠增强MR成像（平均AUC 0.84，95% CI 0.74-0.93，结论超声造影的AUC值明显高于钆塞酸二钠。增强MR成像在评估HCC和DN的动脉血管丰富方面的价值。要点动脉血管丰富是决定肝细胞癌治疗选择的重要特征。可以通过对比增强（CE）超声或磁共振（MR）成像进行评估。CE超声比Gd-EOB更准确。DTPA MRI评估肿瘤内血管情况。应使用CE超声进一步研究低血供肝结节。
Objective To compare contrast-enhanced (CE) ultrasound with gadoxetate disodium-enhanced magnetic resonance (MR) imaging in the assessment of arterial hypervascularity of hepatocellular carcinoma (HCC) and dysplastic nodule (DN), with CT during hepatic arteriography (CTHA) as the reference standard.Methods This study included 54 consecutively diagnosed patients, with 57 histologically confirmed HCCs and 3 DNs (high-grade). All patients underwent CE ultrasound, gadoxetate disodium-enhanced MR imaging and CTHA. Two trained diagnostic radiologists interpreted the CTHA images and rated the degree of intratumoral arterial vascularity by consensus using a five-point confidence scale as the reference standard. In the observer study, the degrees of vascularity on CE ultrasound and gadoxetate disodium-enhanced MR images were qualitatively analysed by four independent readers using a five-point confidence scale. Diagnostic accuracy was analysed by receiver-operating characteristic (ROC) analysis.Results The diagnostic accuracies of the average area under the ROC curve (AUC) were significantly greater with CE ultrasound (average AUC: 0.94; 95% confidence interval [CI]: 0.88-1.00) than with gadoxetate disodium-enhanced MR imaging (average AUC 0.84, 95% CI 0.74-0.93, = 0.0014).Conclusion Contrast-enhanced ultrasound yields a significantly higher AUC value than gadoxetate disodium-enhanced MR imaging in the assessment of arterial hypervascularity of HCC and DN.Key PointsArterial hypervascularity is an important feature determining treatment options in hepatocellular carcinoma.It can be assessed by contrast-enhanced (CE) ultrasound or magnetic resonance (MR) imaging.CE ultrasound was more accurate than Gd-EOB-DTPA MRI in assessing intratumoral vascularity.Hypovascular hepatic nodules should be further investigated using CE ultrasound.