Clinical usefulness of the ablative margin assessed by magnetic resonance imaging with Gd-EOB-DTPA for radiofrequency ablation of hepatocellular carcinoma

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• 作者：Masahiko Koda¹ ; ^{masakoda@grape.med.tottori-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Shiho Tokunaga¹ ; Toshiaki Okamoto¹ ; Masanori Hodozuka¹ ; Kennichi Miyoshi¹ ; Manabu Kishina¹ ; Yuki Fujise¹ ; Jun Kato¹ ; Tomomitsu Matono¹ ; Takaaki Sugihara² ; Kenji Oyama² ; Keiko Hosho² ; Jun-ichi Okano² ; Yoshikazu Murawaki¹ ; Suguru Kakite² ; Eijiro Yamashita²
• 关键词：AM ; ablative margin ; MRI ; magnetic resonance imaging ; RFA ; radiofrequency ablation ; HCC ; hepatocellular carcinoma ; CT ; computed tomography ; Gd-EOB-DTPA ; gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid ; US ; ultrasound ; SN ; simple nodular ; TACE ; transcatheter arterial chemoembolization ; ADC ; apparent diffusion coefficient ; DWI ; diffusion-weighted MRI
• 刊名：Journal of Hepatology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：63
• 期：6
• 页码：1360-1367
• 全文大小：880 K

文摘

The aim of this study was to investigate the feasibility of ablative margin (AM) grading by magnetic resonance imaging (MRI) with Gd-EOB-DTPA administered prior to radiofrequency ablation (RFA), and to identify factors for achieving a sufficient AM and predictors for local tumor progression.

Methods

A total of 124 hepatocellular carcinomas (HCCs) were treated by RFA after Gd-EOB-DTPA administration. MRI and enhanced CT were performed within seven hours and one month after RFA. The AM assessment was categorized using three grades: AM (+), low-intensity area with continuous high-intensity rim; AM zero, low-intensity area with discontinuous high-intensity rim; and AM (−), low-intensity area extends beyond the high-intensity rim. Patients were followed and local tumor progression was observed.

Results

AM (+), AM zero, AM (−), and indeterminate were found in 34, 33, 26, and 31 nodules, respectively. The overall agreement rate between MRI and enhanced CT for the diagnosis of AM was 56.8%. The κ coefficient was 0.326 (p <0.001), indicating moderate agreement. Multivariate logistic regression analysis showed that a significant factor for the achievement of AM (+) on MRI was no contiguous vessels. The cumulative local tumor progression rates (0% at 1, 2, and 3 years) in 33 AM (+) nodules were significantly lower than those (3.6%, 11.5%, and 18.3% at 1, 2, and 3 years respectively) in 32 AM zero nodules. A multivariate Cox proportional hazards model identified tumor size as an independent predictor for local tumor progression.

Conclusion

Gd-EOB-DTPA-MRI enabled an early assessment of RFA effectiveness in the majority of HCC nodules. Local tumor progression was not detected in AM (+) nodules during the follow-up.