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Imaging of HCC-Current State of the Art. Diagnostics (Basel) 2015; 5:513-45. [PMID: 26854169 PMCID: PMC4728473 DOI: 10.3390/diagnostics5040513] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 12/17/2022] Open
Abstract
Early diagnosis of hepatocellular carcinoma (HCC) is crucial for optimizing treatment outcome. Ongoing advances are being made in imaging of HCC regarding detection, grading, staging, and also treatment monitoring. This review gives an overview of the current international guidelines for diagnosing HCC and their discrepancies as well as critically summarizes the role of magnetic resonance imaging (MRI) and computed tomography (CT) techniques for imaging in HCC. The diagnostic performance of MRI with nonspecific and hepatobililiary contrast agents and the role of functional imaging with diffusion-weighted imaging will be discussed. On the other hand, CT as a fast, cheap and easily accessible imaging modality plays a major role in the clinical routine work-up of HCC. Technical advances in CT, such as dual energy CT and volume perfusion CT, are currently being explored for improving detection, characterization and staging of HCC with promising results. Cone beam CT can provide a three-dimensional analysis of the liver with tumor and vessel characterization comparable to cross-sectional imaging so that this technique is gaining an increasing role in the peri-procedural imaging of HCC treated with interventional techniques.
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Yan R, Haopeng P, Xiaoyuan F, Jinsong W, Jiawen Z, Chengjun Y, Tianming Q, Ji X, Mao S, Yueyue D, Yong Z, Jianfeng L, Zhenwei Y. Non-Gaussian diffusion MR imaging of glioma: comparisons of multiple diffusion parameters and correlation with histologic grade and MIB-1 (Ki-67 labeling) index. Neuroradiology 2015; 58:121-32. [PMID: 26494463 DOI: 10.1007/s00234-015-1606-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/02/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study was conducted to compare the association of Gaussian and non-Gaussian magnetic resonance imaging (MRI)-derived parameters with histologic grade and MIB-1 (Ki-67 labeling) index (MI) in brain glioma. METHODS Sixty-five patients with pathologically confirmed glioma, who underwent diffusion-weighted MRI with 2 b values (0, 1000 s/mm(2)) and 22 b values (≤5000 s/mm(2)), respectively, were divided into three groups of grade II (n = 35), grade III (n = 8), and grade IV (n = 22). Comparisons by two groups were made for apparent diffusion coefficient (ADC), slow diffusion coefficient (Dslow), distributed diffusion coefficient (DDC), and heterogeneity index α. Analyses of receiver operating characteristic (ROC) curve were performed to maximize the area under the curve (AUC) for differentiating grade III + IV (high-grade glioma, HGG) from grade II (low-grade glioma, LGG) and grade IV (glioblastoma multiforme, GBM) from grade II + III (other grade glioma, OGG). Correlations with MI were analyzed for the MRI parameters. RESULTS On tumor regions, the values of ADC, Dslow, DDC, and α were significantly higher in grade II [(1.37 ± 0.29, 0.70 ± 0.11, 1.39 ± 0.34) (×10(-3) mm(2)/s) and 0.88 ± 0.05, respectively] than in grade III [(0.99 ± 0.13, 0.55 ± 0.07, 1.04 ± 0.20) (×10(-3) mm(2)/s) and 0.80 ± 0.03, respectively] and grade IV [(1.03 ± 0.14, 0.50 ± 0.05, 1.02 ± 0.16) (×10(-3) mm(2)/s) and 0.76 ± 0.04, respectively] (all P < 0.001). The parameter α showed the highest AUCs of 0.950 and 0.922 in discriminating HGG from LGG and GBM from OGG, respectively. Significant correlations with histologic grade and MI were observed for the MRI parameters. CONCLUSION The non-Gaussian MRI-derived parameters α and Dslow are superior to ADC in glioma grading, which are comparable with ADC as reliable biomarkers in noninvasively predicting the proliferation level of glioma malignancy.
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Affiliation(s)
- Ren Yan
- Department of Radiology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, PR China
| | - Pang Haopeng
- Department of Radiology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, PR China
| | - Feng Xiaoyuan
- Department of Radiology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, PR China.
| | - Wu Jinsong
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Zhang Jiawen
- Department of Radiology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, PR China
| | - Yao Chengjun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Qiu Tianming
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xiong Ji
- Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Sheng Mao
- Department of Imaging, Suzhou Children's Hospital, Suzhou, Jiangsu, PR China
| | - Ding Yueyue
- Department of Imaging, Suzhou Children's Hospital, Suzhou, Jiangsu, PR China
| | - Zhang Yong
- MR Research, GE Healthcare, Shanghai, PR China
| | - Luo Jianfeng
- Department of Biostatistics, Public Health School, Fudan University, Shanghai, PR China
| | - Yao Zhenwei
- Department of Radiology, Huashan Hospital, Fudan University, Mid Wulumuqi Road, Shanghai, 200040, PR China
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153
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Wu WC, Chen YF, Tseng HM, Yang SC, My PC. Caveat of measuring perfusion indexes using intravoxel incoherent motion magnetic resonance imaging in the human brain. Eur Radiol 2015; 25:2485-92. [PMID: 25693668 PMCID: PMC4495260 DOI: 10.1007/s00330-015-3655-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/22/2015] [Accepted: 02/03/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To numerically and experimentally investigate the robustness of intravoxel incoherent motion (IVIM) magnetic resonance imaging in measuring perfusion indexes in the human brain. METHODS Eighteen healthy volunteers were imaged on a 3 T clinical system. Data of IVIM imaging (12 b-values ranging from 0 to 1000 s/mm(2), 12 repetitions) were fitted with a bi-exponential model to extract blood volume fraction (f) and pseudo-diffusion coefficient (D*). The robustness of measurement was assessed by bootstrapping. Dynamic susceptibility contrast (DSC) imaging and arterial spin-labelling (ASL) imaging were performed for cross-modal comparison. Numerical simulations were performed to assess the accuracy and precision of f and D* estimates at varied signal-to-noise ratio (SNRb1000). RESULTS Based on our experimental setting (SNRb1000 ~ 30), the average error/variability is ~5 %/25 % for f and ~100 %/30 % for D* in gray matter, and ~10 %/50 % for f and ~300 %/60 % for D* in white matter. Correlation was found between f and DSC-derived cerebral blood volume in gray matter (r = 0.29 - 0.48 across subjects, p < 10(-5)), but not in white matter. No correlation was found between f-D* product and ASL-derived cerebral blood flow. CONCLUSIONS f may provide noninvasive measurement of cerebral blood volume, particularly in gray matter. D* has limited robustness and should be interpreted with caution. KEY POINTS • A minimum SNR b1000 of 30 is recommended for reliable IVIM imaging. • f may provide noninvasive measurement of cerebral blood volume. • f correlates with CBV DSC in gray matter. • There is no correlation between fD* and CBF ASL . • D* has limited robustness and should be interpreted with caution.
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Affiliation(s)
- Wen-Chau Wu
- Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan,
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154
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Wu H, Hu M, Liu Z, Ye W, Li J, Liu H, Yang J, Liang C. Intravoxel incoherent motion diffusion-weighted MRI for characterizing regional variability and monitoring serial changes of parameters in rabbit VX2 liver tumors. J Magn Reson Imaging 2015; 43:173-80. [PMID: 26130317 DOI: 10.1002/jmri.24989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/12/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To characterize intravoxel incoherent motion (IVIM) parameters in different regions of interest (ROIs) of rabbit VX2 liver tumors during a follow-up of 4 weeks. MATERIALS AND METHODS This study was approved by the Institutional Animal Care and Use Committee. In 18 VX2 liver tumor-bearing rabbits, IVIM DW imaging was serially performed at the 2nd, 3rd, and 4th week separately after tumor implantation at 1.5T by using 12 b values. Three ROIs were drawn on the apparent diffusion coefficient (ADC) maps, including the whole lesion, the visibly most restricted diffusion area (MRDA), and peripheral area of tumor. For each ROI of tumors, serial changes in ADC and D, D*, and f at three timepoints were calculated. The differences of IVIM parameters in different ROIs of tumors at each timepoint were compared. RESULTS Serial measurements of f in all three ROIs (P = 0.000, P = 0.002, and P = 0.000), ADC for the whole lesion, MRDA (P = 0.000 and P = 0.024), and D for MRDA (P = 0.001) from the 2nd to 4th week illustrated a statistical difference. The overall comparison of ADC (P = 0.000, P = 0.014, and P = 0.000), D (P = 0.000, P = 0.001, and P = 0.000), and f (P = 0.001, P = 0.001, and P = 0.000) for three tumor regions at weeks 2, 3, and 4 showed significant differences. D* in all three ROIs at each timepoint showed no significant differences (P = 0.612, P = 0.723, and P = 0.699; 95% confidence interval: 0.184-0.950). CONCLUSION The peripheral area of tumor could be used as an alternative to the whole lesion as ROIs to assess the VX2 liver tumor with IVIM DW imaging, and in the period between weeks 2 and 3.
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Affiliation(s)
- Haijun Wu
- Graduate College, Southern Medical University, Guangzhou, Guangdong Province, P.R. China.,Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Maoqing Hu
- Graduate College, Southern Medical University, Guangzhou, Guangdong Province, P.R. China.,Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Zaiyi Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Weitao Ye
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Jinglei Li
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Jun Yang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Changhong Liang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
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De Robertis R, Tinazzi Martini P, Demozzi E, Puntel G, Ortolani S, Cingarlini S, Ruzzenente A, Guglielmi A, Tortora G, Bassi C, Pederzoli P, D’Onofrio M. Prognostication and response assessment in liver and pancreatic tumors: The new imaging. World J Gastroenterol 2015; 21:6794-6808. [PMID: 26078555 PMCID: PMC4462719 DOI: 10.3748/wjg.v21.i22.6794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/25/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.
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156
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Abstract
Newly developed or advanced methods of ultrasonography and MR imaging provide combined anatomical and quantitative functional information about diffuse and focal liver diseases. Ultrasound elastography has a central role for staging liver fibrosis and an increasing role in grading portal hypertension; dynamic contrast-enhanced ultrasonography may improve tumor characterization. In clinical practice, MR imaging examinations currently include diffusion-weighted and dynamic MR imaging, enhanced with extracellular or hepatobiliary contrast agents. Moreover, quantitative parameters obtained with diffusion-weighted MR imaging, dynamic contrast-enhanced MR imaging and MR elastography have the potential to characterize further diffuse and focal liver diseases, by adding information about tissue cellularity, perfusion, hepatocyte transport function and visco-elasticity. The multiparametric capability of ultrasonography and more markedly of MR imaging gives the opportunity for high diagnostic performance by combining imaging biomarkers. However, image acquisition and post-processing methods should be further standardized and validated in multicenter trials.
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157
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Chen J, Wu M, Liu R, Li S, Gao R, Song B. Preoperative evaluation of the histological grade of hepatocellular carcinoma with diffusion-weighted imaging: a meta-analysis. PLoS One 2015; 10:e0117661. [PMID: 25658359 PMCID: PMC4320049 DOI: 10.1371/journal.pone.0117661] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in the preoperative prediction of the histological grade of hepatocellular carcinoma (HCC). MATERIALS AND METHODS A comprehensive literature search was performed in several authoritative databases to identify relevant articles. QUADAS-2 was used to assess the quality of included studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Summary receiver operating characteristic (SROC) curves were derived and areas under the SROC curve (AUC) were computed to indicate the diagnostic accuracy. Heterogeneity test, meta-regression analysis and sensitivity analysis were performed to identify factors and studies contributed to the heterogeneity. RESULTS A total of 11 studies with 912 HCCs were included in this meta-analysis. The pooled sensitivity, specificity, PLR and NLR with corresponding 95% confidence intervals (CI) were 0.54(0.47-0.61), 0.90(0.87-0.93), 4.88(2.99-7.97) and 0.46(0.27-0.77) for the prediction of well-differentiated HCC (w-HCC), 0.84(0.78-0.89), 0.48(0.43-0.52), 2.29(1.43-3.69) and 0.30(0.22-0.41) for the prediction of poorly-differentiated HCC (p-HCC). The AUC were 0.9311 and 0.8513 in predicting w-HCC and p-HCC, respectively. Results were further evaluated according to the method of image interpretation. Significant heterogeneity was observed. CONCLUSION DWI had excellent and moderately high diagnostic accuracy for the detection of w-HCC and p-HCC, respectively. Nonetheless, further studies in larger populations and an optimized image acquisition and interpretation are required before DWI-derived parameters can be used as a useful image biomarker for the prediction of the histological grade of HCC.
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Affiliation(s)
- Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Mingpeng Wu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Rongbo Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Siyi Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Ronghui Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
- * E-mail:
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158
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Radiology in Transplant. CURRENT TRANSPLANTATION REPORTS 2014. [DOI: 10.1007/s40472-014-0034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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159
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Lee EYP, Hui ESK, Chan KKL, Tse KY, Kwong WK, Chang TY, Chan Q, Khong PL. Relationship between intravoxel incoherent motion diffusion-weighted MRI and dynamic contrast-enhanced MRI in tissue perfusion of cervical cancers. J Magn Reson Imaging 2014; 42:454-9. [PMID: 25413245 DOI: 10.1002/jmri.24808] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Elaine Yuen Phin Lee
- Department of Diagnostic Radiology; Queen Mary Hospital; The University of Hong Kong; Hong Kong China
| | - Edward Sai Kam Hui
- Department of Diagnostic Radiology; Queen Mary Hospital; The University of Hong Kong; Hong Kong China
| | - Karen Kar Loen Chan
- Department of Obstetrics and Gynaecology; Queen Mary Hospital; The University of Hong Kong; Hong Kong China
| | - Ka Yu Tse
- Department of Obstetrics and Gynaecology; Queen Mary Hospital; The University of Hong Kong; Hong Kong China
| | - Wai Kay Kwong
- Department of Clinical Oncology; Queen Mary Hospital; Hong Kong China
| | - Tien Yee Chang
- Department of Clinical Oncology; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | | | - Pek-Lan Khong
- Department of Diagnostic Radiology; Queen Mary Hospital; The University of Hong Kong; Hong Kong China
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Kang TW, Kim SH, Jang KM, Choi D, Ha SY, Kim KM, Kang WK, Kim MJ. Gastrointestinal stromal tumours: correlation of modified NIH risk stratification with diffusion-weighted MR imaging as an imaging biomarker. Eur J Radiol 2014; 84:33-40. [PMID: 25466773 DOI: 10.1016/j.ejrad.2014.10.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/27/2014] [Accepted: 10/28/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the correlation of risk grade of gastrointestinal stromal tumours (GISTs) based on modified National Institutes of Health (NIH) criteria with conventional magnetic resonance (MR) imaging and diffusion-weighted (DW) imaging. METHODS We included 22 patients with histopathologically proven GISTs in the stomach or small bowel who underwent pre-operative gadoxetic acid-enhanced MR imaging and DW imaging. We retrospectively assessed correlations between morphologic findings, qualitative (signal intensity, consensus from two observers) and quantitative (degree of dynamic enhancement using signal intensity of tumour/muscle ratio and apparent diffusion coefficient [ADC]) values, and the modified NIH criteria for risk stratification. Spearman partial correlation analysis was used to control for tumour size as a confounding factor. The optimal cut-off level of ADC values for intermediate or high risk GISTs was analyzed using a receiver operating characteristic analysis. RESULTS Except tumour size and necrosis, conventional MR imaging findings, including the degree of dynamic enhancement, were not significantly different according to the modified NIH criteria (p>0.05). Tumour ADC values were negatively correlated with the modified NIH criteria, before and after adjustment of tumour size (ρ=-0.754; p<0.001 and ρ=-0.513; p=0.017, respectively). The optimal cut-off value for the determination of intermediate or high-risk GISTs was 1.279 × 10(-3)mm(2)/s (100% sensitivity, 69.2% specificity, 81.8% accuracy). CONCLUSION Except tumour size and necrosis, conventional MR imaging findings did not correlate with the risk grade. However, the ADC value can be used as an imaging biomarker to assess the risk grade of GISTs, regardless of tumour size.
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Affiliation(s)
- Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea.
| | - Kyung Mi Jang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - Dongil Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - Sang Yun Ha
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - Kyoung-Mee Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - Won Ki Kang
- Division of Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - Min Ji Kim
- Biostatics Unit, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul 135-710, Republic of Korea
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Wurnig MC, Donati OF, Ulbrich E, Filli L, Kenkel D, Thoeny HC, Boss A. Systematic analysis of the intravoxel incoherent motion threshold separating perfusion and diffusion effects: Proposal of a standardized algorithm. Magn Reson Med 2014; 74:1414-22. [DOI: 10.1002/mrm.25506] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/02/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Moritz C. Wurnig
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
| | - Olivio F. Donati
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
| | - Erika Ulbrich
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
| | - Lukas Filli
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
| | - David Kenkel
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
| | - Harriet C. Thoeny
- Department of Diagnostic and Interventional Radiology; University Hospital Bern; Switzerland
| | - Andreas Boss
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Switzerland
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Lee DH, Lee JM, Baek JH, Shin CI, Han JK, Choi BI. Diagnostic performance of gadoxetic acid-enhanced liver MR imaging in the detection of HCCs and allocation of transplant recipients on the basis of the Milan criteria and UNOS guidelines: correlation with histopathologic findings. Radiology 2014; 274:149-60. [PMID: 25203131 DOI: 10.1148/radiol.14140141] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To determine whether hepatobiliary phase ( HBP hepatobiliary phase ) imaging can improve the diagnostic performance of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging in the detection of hepatocellular carcinomas ( HCC hepatocellular carcinoma s) and to investigate the accuracy of gadoxetic acid-enhanced MR imaging in the allocation of transplant recipients on the basis of the Milan criteria and United Network for Organ Sharing ( UNOS United Network for Organ Sharing ) guidelines. MATERIALS AND METHODS This retrospective study had institutional review board approval; the requirement for informed consent was waived. Between June 2008 and June 2011, 63 patients who underwent liver transplantation (LT) were included. All patients underwent a gadoxetic acid-enhanced 3.0-T MR imaging examination of the liver that included HBP hepatobiliary phase images obtained 20 minutes after contrast material administration. Two abdominal radiologists independently assessed two MR imaging data sets to detect HCC hepatocellular carcinoma s: Set 1 included unenhanced and gadoxetic acid-enhanced dynamic images, and set 2 also included HBP hepatobiliary phase images. Patients were allocated into three groups: Those who did not meet the Milan criteria, those who did meet the Milan criteria with additional priority according to UNOS United Network for Organ Sharing guidelines, and those who did meet the Milan criteria without additional priority. Diagnostic performance of each data set in depicting HCC hepatocellular carcinoma s was compared by using jackknife alternative free-response receiver operating characteristics ( JAFROC jackknife alternative free-response receiver operating characteristic s). Sensitivity and accuracy of patient allocation were compared by using generalized estimating equations. RESULTS Sixty-three HCC hepatocellular carcinoma s were found in 36 of 63 patients. Eight patients were classified as not meeting Milan criteria, 12 as meeting Milan criteria with additional priority, and 43 as meeting Milan criteria without additional priority. For the detection of HCC hepatocellular carcinoma s, reader-averaged figures of merit estimated with JAFROC jackknife alternative free-response receiver operating characteristic s were 0.761 for set 1 and 0.791 for set 2 (P < .001). Addition of HBP hepatobiliary phase images significantly improved sensitivity for the detection of HCC hepatocellular carcinoma s, particularly 1-2-cm HCC hepatocellular carcinoma s (six [20.7%] vs 13 [44.8%] of 29 [P = .008] for reader 1 and eight [27.6%] vs 12 [41.4%] of 29 [P = .041] for reader 2). Accuracy of patient allocation was 88.9% for set 1 and 92.1% for set 2 (P = .151). CONCLUSION Addition of HBP hepatobiliary phase images can significantly improve the diagnostic performance of gadoxetic acid-enhanced liver MR imaging in the detection of 1-2-cm HCC hepatocellular carcinoma s in liver transplantation candidates. In addition, gadoxetic acid-enhanced MR imaging showed 92.1% accuracy in patient allocation on the basis of the Milan criteria and UNOS United Network for Organ Sharing guidelines.
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Affiliation(s)
- Dong Ho Lee
- From the Department of Radiology (D.H.L., J.M.L., J.H.B., C.i.S., J.K.H., B.I.C.) and Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
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