BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) usi...BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2. AIM To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1). METHODS Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusionweighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules. RESULTS There were 39 (34.2%;39 of 114) and 75 (65.8%;75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings, i.e., corona enhancement [odds ratio = 2.67;95% confidence interval: 1.101-6.480] and peritumoral hypointensity in HB phase images (odds ratio = 2.203;95% confidence interval: 0.961-5.049) were associated with high risk of pT2 HCC. The positive likelihood ratio was 6.25 (95% confidence interval: 1.788-21.845), and sensitivity of EOB-MRI for detecting pT2 HCC was 86.2% when two or three of these MRI features were present. Small tumor size and hypointense rim in the HB phase were regarded as benign features. Small HCCs with hypointense rim but not associated with aggressive features were mostly pT1 lesions (specificity, 100%). CONCLUSION Imaging features on EOB-MRI could potentially be used to predict the pathologic stage of solitary HCC (cT1) as pT1 or pT2.展开更多
Gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI) achieves excellent lesion detection and characterization for both hypervascular hepatocellula...Gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI) achieves excellent lesion detection and characterization for both hypervascular hepatocellular carcinoma(HCC) in arterial phase imagingand hypovascular early HCC(small well-differentiated HCC of the vaguely nodular type) in hepatobiliary phase imaging, and has become an indispensable imaging modality in the treatment of HCC. Early HCCs have been detected more frequently since the introduction of EOB-MRI into daily clinical practice. Early HCC is known to progress to conventional hypervascular HCC, and many risk factors have been identified for the hypervascularization of early HCC including the diameter of the tumor, presence of fat, and imaging findings of EOB-MRI. The rate of the development of hypervascular HCC was previously reported to be high in patients with chronic liver disease and early HCC. The presence of early HCC is regarded as a predictor for the recurrence of HCC following hepatic resection. On the other hand, although early HCC itself is currently not regarded as a target lesion for hepatic resection, early HCC at high risk of hypervascularity needs to be treated by local ablation therapy. If concomitant early HCC with progressed HCC is at high risk of hypervascularization and the functional liver reserve of a patient is sufficient, its simultaneous treatment at the time of hepatic resection for progressed HCC is recommended. Further studies on larger numbers of patients are needed before this strategy is adopted.展开更多
目的比较两种注射速度(1、1.5 m L/s)钆塞酸二钠(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid,Gd-EOB-DTPA)增强磁共振(magnetic resonance,MR)肝脏动态增强动脉期图像质量的优劣性。方法回顾性评估本院2012年12月至2...目的比较两种注射速度(1、1.5 m L/s)钆塞酸二钠(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid,Gd-EOB-DTPA)增强磁共振(magnetic resonance,MR)肝脏动态增强动脉期图像质量的优劣性。方法回顾性评估本院2012年12月至2013年9月接受Gd-EOB-DTPA肝脏MR动态增强检查的患者106例,包括注射速度为1 m L/s患者52例,1.5 m L/s患者54例,对动脉期增强图像进行评估。由2名副高以上诊断医师定量评估所有患者肝脏动脉期腹主动脉、肝总动脉、肝脏实质的信噪比(signal noise ratio,SNR)和强化率(contrast-enhancement ratio,CER)的差异性,定性评估腹主动脉、肝总动脉、肝脏实质、门静脉和图像伪影5个项目得分和总分的差异性。结果 Gd-EOB-DTPA注射速度为1 m L/s组和1.5 m L/s组各部分SNR和CER差异无统计学意义(P>0.05),1 m L/s组腹主动脉、肝总动脉强化评分和总分均高于1.5 m L/s组(P<0.05)。结论 Gd-EOB-DTPA注射速度为1 m L/s的肝脏动脉期图像质量优于注射速度为1.5 m L/s的肝脏动脉期图像质量。展开更多
文摘BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2. AIM To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1). METHODS Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusionweighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules. RESULTS There were 39 (34.2%;39 of 114) and 75 (65.8%;75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings, i.e., corona enhancement [odds ratio = 2.67;95% confidence interval: 1.101-6.480] and peritumoral hypointensity in HB phase images (odds ratio = 2.203;95% confidence interval: 0.961-5.049) were associated with high risk of pT2 HCC. The positive likelihood ratio was 6.25 (95% confidence interval: 1.788-21.845), and sensitivity of EOB-MRI for detecting pT2 HCC was 86.2% when two or three of these MRI features were present. Small tumor size and hypointense rim in the HB phase were regarded as benign features. Small HCCs with hypointense rim but not associated with aggressive features were mostly pT1 lesions (specificity, 100%). CONCLUSION Imaging features on EOB-MRI could potentially be used to predict the pathologic stage of solitary HCC (cT1) as pT1 or pT2.
文摘Gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI) achieves excellent lesion detection and characterization for both hypervascular hepatocellular carcinoma(HCC) in arterial phase imagingand hypovascular early HCC(small well-differentiated HCC of the vaguely nodular type) in hepatobiliary phase imaging, and has become an indispensable imaging modality in the treatment of HCC. Early HCCs have been detected more frequently since the introduction of EOB-MRI into daily clinical practice. Early HCC is known to progress to conventional hypervascular HCC, and many risk factors have been identified for the hypervascularization of early HCC including the diameter of the tumor, presence of fat, and imaging findings of EOB-MRI. The rate of the development of hypervascular HCC was previously reported to be high in patients with chronic liver disease and early HCC. The presence of early HCC is regarded as a predictor for the recurrence of HCC following hepatic resection. On the other hand, although early HCC itself is currently not regarded as a target lesion for hepatic resection, early HCC at high risk of hypervascularity needs to be treated by local ablation therapy. If concomitant early HCC with progressed HCC is at high risk of hypervascularization and the functional liver reserve of a patient is sufficient, its simultaneous treatment at the time of hepatic resection for progressed HCC is recommended. Further studies on larger numbers of patients are needed before this strategy is adopted.
文摘目的比较两种注射速度(1、1.5 m L/s)钆塞酸二钠(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid,Gd-EOB-DTPA)增强磁共振(magnetic resonance,MR)肝脏动态增强动脉期图像质量的优劣性。方法回顾性评估本院2012年12月至2013年9月接受Gd-EOB-DTPA肝脏MR动态增强检查的患者106例,包括注射速度为1 m L/s患者52例,1.5 m L/s患者54例,对动脉期增强图像进行评估。由2名副高以上诊断医师定量评估所有患者肝脏动脉期腹主动脉、肝总动脉、肝脏实质的信噪比(signal noise ratio,SNR)和强化率(contrast-enhancement ratio,CER)的差异性,定性评估腹主动脉、肝总动脉、肝脏实质、门静脉和图像伪影5个项目得分和总分的差异性。结果 Gd-EOB-DTPA注射速度为1 m L/s组和1.5 m L/s组各部分SNR和CER差异无统计学意义(P>0.05),1 m L/s组腹主动脉、肝总动脉强化评分和总分均高于1.5 m L/s组(P<0.05)。结论 Gd-EOB-DTPA注射速度为1 m L/s的肝脏动脉期图像质量优于注射速度为1.5 m L/s的肝脏动脉期图像质量。
