Diagnostic criteria for hepatocellular carcinoma ⩿ cm with hepatocyte-specific contrast-enhanced magnetic resonance imaging

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• 作者：Sang Hyun Choi¹ ; Jae Ho Byun¹ ; ^{jhbyun@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Young-Suk Lim² ; Eunsil Yu³ ; So Jung Lee¹ ; So Yeon Kim¹ ; Hyung Jin Won¹ ; Yong Moon Shin¹ ; Pyo Nyun Kim¹
• 关键词：HCC ; hepatocellular carcinoma ; CT ; computed tomography ; MRI ; magnetic resonace imaging ; RFA ; radiofrequency ablation ; EASL ; European Association for the Study of the Liver ; AASLD ; American Association for the Study of Liver Disease ; BCLC ; Barcelona Clinic Liver Cancer ; TACE ; transcatheter arterial chemoembolization ; FLASH ; fast low-angle shot ; VIBE ; volumetric interpolated breath-hold examination ; DWI ; diffusion-weighted imaging ; PPV ; positive predictive value ; NPV ; negative predictive value ; OR
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：64
• 期：5
• 页码：1099-1107
• 全文大小：1072 K

文摘

Current diagnostic imaging criteria for hepatocellular carcinoma (HCC) are dedicated to imaging with nonspecific extracellular contrast agents. This study aimed to evaluate diagnostic criteria for HCC ⩽3 cm on magnetic resonance imaging (MRI) with a hepatocyte-specific contrast agent through an inception cohort study.

Methods

Of 291 patients with chronic liver disease and new nodules of 1–3 cm in diameter at surveillance ultrasonography, 295 solid nodules (194 HCCs, 98 benign nodules, and three other malignancies) in 198 patients with a confirmed final diagnosis or ⩾24 months follow-up were evaluated on gadoxetic acid-enhanced MRI. Through univariate and multivariate logistic regression analyses, various diagnostic criteria were developed by combining significant MRI findings for diagnosing HCC. The diagnostic performance of each criterion was compared with that of the European Association for the Study of the Liver (EASL) criteria.

Results

Four MRI findings (arterial-phase hyperintensity, transitional-phase hypointensity, hepatobiliary-phase hypointensity, and rim enhancement) were independently significant for diagnosis of HCC ⩽3 cm. For whole nodules, EASL criteria showed the best performance for diagnosing HCC (sensitivity, 83.5%; specificity, 81.2%). For nodules ⩽2 cm in diameter, a new criterion (arterial-phase hyperintensity and hepatobiliary-phase hypointensity) showed a significantly higher sensitivity than that of the EASL criteria (83.0% vs. 74.5%, p = 0.008), without a significantly different specificity (76.7% vs. 81.1%, p = 0.125).

Conclusions

EASL criteria exhibit the best diagnostic performance for HCC ⩽3 cm on hepatocyte-specific contrast-enhanced MRI. A newly identified criterion (arterial-phase hyperintensity and hepatobiliary-phase hypointensity) may increase the diagnostic sensitivity of small (⩽2 cm) HCC.