Comparison of Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging and Contrast-Enhanced Computed Tomography for the Noninvasive Diagnosis of Hepatocellular Carcinoma.

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver Cancer Pub Date : 2025-04-22 DOI:10.1159/000545965

Jeong Hee Yoon, Won Chang, Young Kon Kim, Chang Hee Lee, Jeong Woo Kim, Beom Jin Park, Jin-Young Choi, Seung-Seob Kim, Hee Sun Park, Eun Sun Lee, Jeong-Sik Yu, Seong Jin Park, Myung-Won You, Myoung-Jin Jang, Joon-Il Choi, Jeong Min Lee

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引用次数: 0

Abstract

Introduction: Magnetic resonance imaging (MRI) has been shown to outperform computed tomography (CT) in diagnosing hepatocellular carcinoma (HCC), although inconsistencies exist across studies. We compared the performance of CT and gadoxetic acid-enhanced MRI in diagnosing HCC according to various guidelines, and to assess the incremental value of a second-line examination.

Methods: This retrospective multicenter study included patients at risk of developing HCC with focal liver lesions (FLLs) ≥10 mm. These patients underwent both contrast-enhanced CT and gadoxetic acid-enhanced MRI between January 2015 and June 2018. Four radiologists independently assessed the images using criteria from the Liver Imaging Reporting and Data System (LI-RADS), the Asian Pacific Association for the Study of the Liver (APASL), and the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) guidelines. The diagnostic performance of CT and MRI was compared across guidelines.

Results: In total, 1,590 FLLs (median size, 22.6 mm) were analyzed in 1,455 patients (median age, 59 years; male, 1,101). Sensitivity was higher with MRI than with CT for APASL (89.3% [95% CI: 87.7%, 90.8%] vs. 78.9% [95% CI: 77.0%, 80.8%], respectively) and KLCA-NCC (78.7% [95% CI: 76.7%, 85.0%] vs. 73.7% [95% CI: 71.6%, 75.7%], respectively) (p = 0.002 for both). However, LI-RADS showed lower sensitivity with MRI than with CT (70.6% [95% CI: 68.4%, 72.6%] vs. 74.7% [95% CI: 72.6%, 76.7%], p = 0.002), due to fewer nonperipheral washout. MRI re-categorized 22.4%, 32.2%, and 53.5% of non-HCC observations on CT as HCC with LI-RADS, KLCA-NCC, and APASL, respectively. CT re-classified 30.2%, 29.0%, and 25.8% of non-HCC observations on MRI as HCC with LI-RADS, KLCA-NCC, and APASL, respectively.

Conclusion: The added value of gadoxetic acid-enhanced MRI after CT depends on the diagnostic criteria used. Restricting washout timing to the portal venous phase in LI-RADS reduces the sensitivity of gadoxetic acid-enhanced MRI relative to CT.

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加多etic酸增强肝磁共振成像与增强ct对肝细胞癌无创诊断的比较。

导语：磁共振成像（MRI）已被证明在诊断肝细胞癌（HCC）方面优于计算机断层扫描（CT），尽管各研究之间存在不一致。根据不同的指南，我们比较了CT和gadoxetic酸增强MRI在诊断HCC方面的表现，并评估二线检查的增量价值。方法：这项回顾性多中心研究纳入了局灶性肝病变(fll)≥10 mm的有发生HCC风险的患者。这些患者在2015年1月至2018年6月期间接受了对比增强CT和加多etic酸增强MRI。四名放射科医生使用肝脏成像报告和数据系统（LI-RADS）、亚太肝脏研究协会（APASL）和韩国肝癌协会-国家癌症中心（KLCA-NCC）指南的标准独立评估图像。根据指南比较CT和MRI的诊断性能。结果：1455例患者(中位年龄59岁；男,1101年)。MRI对APASL的敏感性高于CT（分别为89.3% [95% CI: 87.7%， 90.8%]对78.9% [95% CI: 77.0%, 80.8%]）和KLCA-NCC（分别为78.7% [95% CI: 76.7%， 85.0%]对73.7% [95% CI: 71.6%, 75.7%]）（两者p = 0.002）。然而，由于非外周洗脱较少，MRI LI-RADS的敏感性低于CT （70.6% [95% CI: 68.4%， 72.6%]对74.7% [95% CI: 72.6%, 76.7%], p = 0.002）。MRI将CT上观察到的22.4%、32.2%和53.5%的非HCC重新分类为LI-RADS、KLCA-NCC和APASL的HCC。CT将MRI上观察到的30.2%、29.0%和25.8%的非HCC重新分类为LI-RADS、KLCA-NCC和APASL。结论：CT后加多赛特酸增强MRI的附加价值取决于所采用的诊断标准。在LI-RADS中，将冲洗时间限制在门静脉期会降低加多乙酸增强MRI相对于CT的敏感性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver Cancer Medicine-Oncology

CiteScore

20.80

自引率

7.20%

发文量

审稿时长

16 weeks

期刊介绍： Liver Cancer is a journal that serves the international community of researchers and clinicians by providing a platform for research results related to the causes, mechanisms, and therapy of liver cancer. It focuses on molecular carcinogenesis, prevention, surveillance, diagnosis, and treatment, including molecular targeted therapy. The journal publishes clinical and translational research in the field of liver cancer in both humans and experimental models. It publishes original and review articles and has an Impact Factor of 13.8. The journal is indexed and abstracted in various platforms including PubMed, PubMed Central, Web of Science, Science Citation Index, Science Citation Index Expanded, Google Scholar, DOAJ, Chemical Abstracts Service, Scopus, Embase, Pathway Studio, and WorldCat.