肝硬化患者肝细胞癌，早期肝细胞癌和Gd-EOB-DTPA MRI高度不典

StephenW

                GI cancer


  
   
                Original article


  
   
                      New hallmark of hepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm
        
  
  
   
                                      

• Matteo Renzulli1,
• Maurizio Biselli2,
• Stefano Brocchi1,
• Alessandro Granito3,
• Francesco Vasuri4,
• Francesco Tovoli3,
• Elisa Sessagesimi1,
• Fabio Piscaglia3,
• Antonietta D’Errico4,
• Luigi Bolondi3,
• Rita Golfieri1
  

Author affiliations

• Radiology Unit, Department of Diagnostic Medicine and Prevention, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
• Department of Medical and Surgical Sciences, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
• Unit of Internal Medicine, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
• ‘F Addarii’ Institute of Oncology and Transplantation Pathology, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
  

• Correspondence to Dr Matteo Renzulli, Department of Medical and Surgical Sciences, Sant’Orsola Hospital, University of Bologna, Bologna 40126, Italy; [email protected]
  

  
   
               
Abstract

Objective Many improvements have been made in diagnosing hepatocellular carcinoma (HCC), but the radiological hallmarks of HCC have remained the same for many years. We prospectively evaluated the imaging criteria of HCC, early HCC and high-grade dysplastic nodules (HGDNs) in patients under surveillance for chronic liver disease, using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MRI and diffusion-weighted imaging.

Design Our study population included 420 nodules >1 cm in 228 patients. The MRI findings of each nodule were collected in all sequences/phases. The diagnosis of HCC was made according to the American Association for the Study of Liver Diseases (AASLD) criteria; all atypical nodules were diagnosed using histology.

Results A classification and regression tree was developed using three MRI findings which were independently significant correlated variables for early HCC/HCC, and the best sequence of their application in a new diagnostic algorithm (hepatobiliary hypointensity, arterial hyperintensity and diffusion restriction) was suggested. This algorithm demonstrated, both in the entire study population and for nodules ≤2 cm, higher sensitivity (96% [95% CI 93.5% to 97.6%] and 96.6% [95% CI 93.9% to 98.5%], P<0.001, respectively) and slightly lower specificity (91.8% [95% CI 88.6% to 94.1%], P=0.063, and 92.7% [95% CI 88.9% to 95.4%], P=0.125, respectively) than those of the AASLD criteria. Our new diagnostic algorithm also showed a very high sensitivity (94.7%; 95% CI 92% to 96.6%) and specificity (99.3%; 95% CI 97.7% to 99.8%) in classifying HGDN.

Conclusion Our new diagnostic algorithm demonstrated significantly higher sensitivity and comparable specificity than those of the AASLD imaging criteria for HCC in patients with cirrhosis evaluated using Gd-EOB-DTPA MRI, even for lesions ≤2 cm. Moreover, this diagnostic algorithm allowed evaluating other lesions which could arise in a cirrhotic liver, such as early HCC and HGDN.

  
   
                          

  
   
                http://dx.doi.org/10.1136/gutjnl-2017-315384
  
   

StephenW

胃肠癌
来源文章
肝硬化患者肝细胞癌，早期肝细胞癌和Gd-EOB-DTPA MRI高度不典型增生结节的新特点：一种新的诊断算法

    Matteo Renzulli1，Maurizio Biselli2，Stefano Brocchi1，Alessandro Granito3，Francesco Vasuri4，Francesco Tovoli3，Elisa Sessagesimi1，Fabio Piscaglia3，Antonietta D'Errico4，Luigi Bolondi3，Rita Golfieri1

作者从属关系

    意大利博洛尼亚大学圣欧索拉医院诊断医学与预防系放射科
    意大利博洛尼亚博洛尼亚大学Sant'Orsola医院医学和外科学系
    意大利博洛尼亚博洛尼亚大学医学与外科学系（DIMEC）内科单位
    'F Addarii'意大利博洛尼亚大学Sant'Orsola医院肿瘤与移植病理研究所

    博洛尼亚大学Sant'Orsola医院医学和外科学系Matteo Renzulli博士，意大利博洛尼亚40126; [email protected]

抽象

目的肝细胞肝癌（hepatocellular carcinoma，HCC）的诊断虽有不少进展，但HCC的放射学特征多年来一直保持不变。我们前瞻性评估了使用钆 - 乙氧基苄基 - 二乙烯三胺五乙酸（Gd-EOB-DTPA）MRI和弥散加权成像对慢性肝病监测患者的HCC，早期HCC和高度不典型增生结节（HGDN） 。

设计我们的研究人群包括228例患者中420个> 1 cm的结节。所有序列/阶段收集每个结节的MRI结果。根据美国肝病研究协会（AASLD）标准对HCC进行诊断;所有非典型结节均使用组织学诊断。

结果利用3个MRI检查结果建立了一个分类回归树，该结果是早期HCC / HCC的独立显着相关变量，并提出了其在新的诊断算法（肝胆低信号，动脉高信号和扩散限制）中的最佳应用顺序。这种算法在整个研究人群和结节≤2厘米均表现出较高的敏感性（96％[95％CI 93.5％〜97.6％]和96.6％[95％CI 93.9％〜98.5％]，P <0.001， （分别为91.8％[95％CI 88.6％〜94.1％]，P = 0.063,92.7％[95％CI 88.9％〜95.4％]，P = 0.125） 。我们的新诊断算法在HGDN分类中也表现出非常高的灵敏度（94.7％; 95％CI92％〜96.6％）和特异性（99.3％; 95％CI97.7％〜99.8％）。

结论我们的新诊断算法比使用Gd-EOB-DTPA MRI评估的肝硬化患者的AASLD成像标准具有更高的灵敏度和可比的特异性，即使对于≤2cm的病变也是如此。此外，这种诊断算法允许评估肝硬化肝脏可能出现的其他病变，如早期HCC和HGDN。

http://dx.doi.org/10.1136/gutjnl-2017-315384