MRI在更少的时间里发现更多的肝癌病例，而不是超声检查

StephenW

MRI finds more cases of liver cancer than ultrasonography in less time

Park HJ, et al. J Hepatol. 2019;doi:10.1016/j.jhep.2019.12.001.
December 23, 2019

Nonenhanced MRI showed promise as an option for hepatocellular carcinoma surveillance in high-risk patients based on high-performance results with a short scan time and lack of contrast agent-associated risks, according to a study published in Journal of Hepatology.

According to Hyo Jung Park, MD, from University of Ulsan College of Medicine in the Republic of Korea, and colleagues, recent studies have shown that ultrasonography had a low sensitivity of approximately 63% for detecting early HCC and 20% for very early-stage HCC. Instead, recently revised guidelines suggest that patients with inadequate ultrasonography results be assessed by alternative methods.

“Nonenhanced MRI, consisting of diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI), may be a candidate alternative surveillance tool for HCC, because diffusion restriction and mild to moderate T2 hyperintensity are ancillary imaging features for malignancy,” the researchers wrote.

Park and colleagues enrolled 382 patients with a high risk for HCC who finished at least one surveillance round with reference examination, either histologic examination or CT. They initially diagnosed 48 cases of HCC in 43 patients and cases of HCC in an additional 29 patients during an average follow-up of 32.9 months.

Nonenhanced MRI had superior per-lesion sensitivity (77.1% vs. 25%; P < .001), per-exam sensitivity (79.1% vs. 27.9%; P < .001), per-exam specificity (97.9% vs. 94.5%; P < .001), per-exam negative predictive value (99.1% vs. 96.9%), per-lesion positive predictive value (56.9% vs. 16.7%) and per-exam positive predictive value (61.8% vs. 17.7%) compared with ultrasonography.

The estimated scan time for DWI and T2WI was less than 6 minutes for nonenhanced MRI. However, patient stay duration of MRI was approximately 25 minutes to 35 minutes compared with 12 minutes to 15 minutes for ultrasonography.

“From a viewpoint of utilizing medical resources, not only scan time but also total room occupancy time need to be considered,” Park and colleagues wrote. “Successful use of MRI for surveillance requires simplification of the scanning method and the evaluation of only essential image sequences, thereby maximizing its efficacy while minimizing surveillance time and cost.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.

StephenW

MRI在更少的时间里发现更多的肝癌病例，而不是超声检查

Park HJ等。 J肝素。 2019; doi：10.1016 / j.jhep.2019.12.001。
2019年12月23日

根据发表在《肝病学杂志》上的一项研究，基于增强的结果，短的扫描时间和缺乏与造影剂相关的风险，MRI对高危患者的肝细胞癌监视显示出一种前景。

大韩民国蔚山大学医学院的医学博士Hyo Jung Park和同事们说，最近的研究表明，超声检查对早期HCC的敏感性较低，约为63％，对早期肝癌的敏感性为20％。肝癌取而代之的是，最近修订的指南建议，超声检查结果不足的患者应通过其他方法进行评估。

“由弥散加权成像（DWI）和T2加权成像（T2WI）组成的非增强MRI可能是HCC的备选监视工具，因为弥散受限和轻度至中度的T2高血压是恶性肿瘤的辅助影像学特征，”研究人员写道。

Park及其同事招募了382例HCC高危患者，他们至少完成了至少一轮监测，并接受了组织学检查或CT检查。他们最初平均随访32.9个月，诊断出43例患者中的48例HCC，另外29例中的HCC病例。

非增强MRI的每次病变敏感性（77.1％vs. 25％; P <.001），每次检查敏感性（79.1％vs. 27.9％; P <.001），每次检查特异性（97.9％vs. 94.5）更高％; P <.001），每次检查阴性预测值（99.1％vs. 96.9％），每病灶阳性预测值（56.9％vs. 16.7％）和每次检查阳性预测值（61.8％vs. 17.7） ％）与超声检查相比。

对于非增强MRI，DWI和T2WI的估计扫描时间少于6分钟。但是，MRI的患者停留时间约为25分钟至35分钟，而超声检查则为12分钟至15分钟。

“从利用医疗资源的角度来看，不仅要考虑扫描时间，还要考虑房间的总占用时间，” Park及其同事写道。 “成功使用MRI进行监视需要简化扫描方法，并仅对基本图像序列进行评估，从而在最大限度地减少监视时间和成本的同时，最大化其功效。” – Talitha Bennett

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