W. Ouedraogo , J. Tran-Van Nhieu , L. Baranes , S.-J. Lin , T. Decaens , A. Laurent , M. Djabbari , F. Pigneur , C. Duvoux , H. Kobeiter , J.-F. Deux , A. Rahmouni , A. Luciani
{"title":"肝移植前mri无创诊断标准评价(2010):mri与肝移植的解剖病理相关性","authors":"W. Ouedraogo , J. Tran-Van Nhieu , L. Baranes , S.-J. Lin , T. Decaens , A. Laurent , M. Djabbari , F. Pigneur , C. Duvoux , H. Kobeiter , J.-F. Deux , A. Rahmouni , A. Luciani","doi":"10.1016/j.jradio.2011.03.020","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>To validate the 2010 diagnostic criteria from the American Association for the Study of Liver Diseases (AASLD) for hepatocellular carcinoma (HCC) on MRI using the surgical liver specimen as a gold standard.</p></div><div><h3>Patients and methods</h3><p>A total of 21 liver transplant recipients were retrospectively included. Each underwent surgery because of HCC between January 2007 and January 2008. Pre-transplant MRI was performed on a 1.5 Tesla MR unit. The T1W and T2W signal and kinetic contrast enhancement were correlated for each lesion with the surgical specimen. Lesion diameters between MRI and specimen were compared (Spearman). A multivariate model was created (R statistics software package) to predict the presence and grade of tumor differentiation (WHO, Edmonson Steiner).</p></div><div><h3>Results</h3><p>A total of 71 nodules were detected at histology, including 54 HCC (mean size: 25.3<!--> <!-->mm) compared to 68 on MRI. There was moderate agreement (<em>r</em> <!-->=<!--> <!-->0.58, <em>P</em> <!--><<!--> <!-->0.001) between the maximum lesion diameters measured on MRI and at histology. Wash-out on MRI provided an accuracy of 75 % for the detection of HCC (sensitivity<!--> <!-->=<!--> <!-->75 %, specificity<!--> <!-->=<!--> <!-->76 %). Adding T2W hyperintensity to the AASLD criteria increased the sensitivity of MRI from 70.3 % to 77.7 % for the diagnosis of HCC and from 67.6 % to 79 % for nodules less than 20<!--> <!-->mm in diameter, without affecting specificity. On multivariate analysis, wash out as a single variable was significantly associated with a diagnosis of HCC (<em>P</em> <!--><<!--> <!-->0.01, odds ratio 12.0, CI 95 % [2.6–55.5]). T1W hyperintensity (<em>P</em> <!-->=<!--> <!-->0.04, odds ratio 5.4) and loss of signal on opposed-phase images (<em>P</em> <!-->=<!--> <!-->0.02, odds ratio 9.2) were predictive of good differentiation.</p></div><div><h3>Conclusion</h3><p>On MRI, the AASLD criteria or presence of wash out within a liver nodule in patients with underlying chronic hepatocellular disease are suggestive of tumoral transformation. The addition of T2W hyperintensity to the AASLD criteria increases the detection of HCC, especially nodules smaller than 20<!--> <!-->mm.</p></div>","PeriodicalId":14813,"journal":{"name":"Journal De Radiologie","volume":"92 7","pages":"Pages 688-700"},"PeriodicalIF":0.0000,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jradio.2011.03.020","citationCount":"18","resultStr":"{\"title\":\"Évaluation des critères diagnostiques non invasifs du carcinome hépatocellulaire sur IRM pré-greffe hépatique (2010) : corrélations IRM – anatomopathologiques sur explants hépatiques\",\"authors\":\"W. Ouedraogo , J. Tran-Van Nhieu , L. Baranes , S.-J. Lin , T. Decaens , A. Laurent , M. Djabbari , F. Pigneur , C. Duvoux , H. Kobeiter , J.-F. Deux , A. Rahmouni , A. Luciani\",\"doi\":\"10.1016/j.jradio.2011.03.020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>To validate the 2010 diagnostic criteria from the American Association for the Study of Liver Diseases (AASLD) for hepatocellular carcinoma (HCC) on MRI using the surgical liver specimen as a gold standard.</p></div><div><h3>Patients and methods</h3><p>A total of 21 liver transplant recipients were retrospectively included. Each underwent surgery because of HCC between January 2007 and January 2008. Pre-transplant MRI was performed on a 1.5 Tesla MR unit. The T1W and T2W signal and kinetic contrast enhancement were correlated for each lesion with the surgical specimen. Lesion diameters between MRI and specimen were compared (Spearman). A multivariate model was created (R statistics software package) to predict the presence and grade of tumor differentiation (WHO, Edmonson Steiner).</p></div><div><h3>Results</h3><p>A total of 71 nodules were detected at histology, including 54 HCC (mean size: 25.3<!--> <!-->mm) compared to 68 on MRI. There was moderate agreement (<em>r</em> <!-->=<!--> <!-->0.58, <em>P</em> <!--><<!--> <!-->0.001) between the maximum lesion diameters measured on MRI and at histology. Wash-out on MRI provided an accuracy of 75 % for the detection of HCC (sensitivity<!--> <!-->=<!--> <!-->75 %, specificity<!--> <!-->=<!--> <!-->76 %). Adding T2W hyperintensity to the AASLD criteria increased the sensitivity of MRI from 70.3 % to 77.7 % for the diagnosis of HCC and from 67.6 % to 79 % for nodules less than 20<!--> <!-->mm in diameter, without affecting specificity. 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The addition of T2W hyperintensity to the AASLD criteria increases the detection of HCC, especially nodules smaller than 20<!--> <!-->mm.</p></div>\",\"PeriodicalId\":14813,\"journal\":{\"name\":\"Journal De Radiologie\",\"volume\":\"92 7\",\"pages\":\"Pages 688-700\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2011-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.jradio.2011.03.020\",\"citationCount\":\"18\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal De Radiologie\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0221036311002848\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal De Radiologie","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0221036311002848","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 18
摘要
目的以手术肝标本为金标准，验证2010年美国肝脏疾病研究协会(AASLD)对肝细胞癌(HCC)的MRI诊断标准。患者和方法回顾性分析肝移植受者21例。在2007年1月至2008年1月期间，每位患者都因HCC接受了手术。移植前MRI在1.5 Tesla MR设备上进行。每个病变的T1W和T2W信号以及动态对比增强与手术标本相关。比较MRI与标本病变直径(Spearman)。建立多变量模型(R统计软件包)预测肿瘤分化的存在和分级(WHO, Edmonson Steiner)。结果组织学检查共发现71个结节，其中肝癌54个，平均大小25.3 mm, MRI检查68个。有中度一致性(r = 0.58, P <MRI测量的最大病变直径与组织学测量的最大病变直径之间存在0.001)。MRI洗脱检测HCC的准确率为75%(敏感性为75%，特异性为76%)。在AASLD标准中增加T2W高强度，可使MRI诊断HCC的敏感性从70.3%提高到77.7%，对直径小于20mm的结节的敏感性从67.6%提高到79%，但不影响特异性。在多变量分析中，洗出作为一个单一变量与HCC的诊断显著相关(P <0.01，优势比12.0,CI 95%[2.6 ~ 55.5])。T1W高信号(P = 0.04，比值比5.4)和对相图像信号缺失(P = 0.02，比值比9.2)预示分化良好。结论在MRI上，慢性肝细胞病患者的AASLD标准或肝结节内出现冲洗提示肿瘤转化。在AASLD标准中增加T2W高信号可增加HCC的检出率，尤其是小于20mm的结节。
Évaluation des critères diagnostiques non invasifs du carcinome hépatocellulaire sur IRM pré-greffe hépatique (2010) : corrélations IRM – anatomopathologiques sur explants hépatiques
Purpose
To validate the 2010 diagnostic criteria from the American Association for the Study of Liver Diseases (AASLD) for hepatocellular carcinoma (HCC) on MRI using the surgical liver specimen as a gold standard.
Patients and methods
A total of 21 liver transplant recipients were retrospectively included. Each underwent surgery because of HCC between January 2007 and January 2008. Pre-transplant MRI was performed on a 1.5 Tesla MR unit. The T1W and T2W signal and kinetic contrast enhancement were correlated for each lesion with the surgical specimen. Lesion diameters between MRI and specimen were compared (Spearman). A multivariate model was created (R statistics software package) to predict the presence and grade of tumor differentiation (WHO, Edmonson Steiner).
Results
A total of 71 nodules were detected at histology, including 54 HCC (mean size: 25.3 mm) compared to 68 on MRI. There was moderate agreement (r = 0.58, P < 0.001) between the maximum lesion diameters measured on MRI and at histology. Wash-out on MRI provided an accuracy of 75 % for the detection of HCC (sensitivity = 75 %, specificity = 76 %). Adding T2W hyperintensity to the AASLD criteria increased the sensitivity of MRI from 70.3 % to 77.7 % for the diagnosis of HCC and from 67.6 % to 79 % for nodules less than 20 mm in diameter, without affecting specificity. On multivariate analysis, wash out as a single variable was significantly associated with a diagnosis of HCC (P < 0.01, odds ratio 12.0, CI 95 % [2.6–55.5]). T1W hyperintensity (P = 0.04, odds ratio 5.4) and loss of signal on opposed-phase images (P = 0.02, odds ratio 9.2) were predictive of good differentiation.
Conclusion
On MRI, the AASLD criteria or presence of wash out within a liver nodule in patients with underlying chronic hepatocellular disease are suggestive of tumoral transformation. The addition of T2W hyperintensity to the AASLD criteria increases the detection of HCC, especially nodules smaller than 20 mm.
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