Background/purpose

Imaging diagnosis of hepatocellular carcinoma (HCC) is important, but the diagnostic performance of combined computed tomography (CT) and magnetic resonance imaging (MRI) using the Liver Imaging Reporting and Data System (LI-RADS) v2018 is not fully understood. We evaluated the clinical usefulness of combined CT and MRI for diagnosing HCC ≤ 3.0 cm using LI-RADS.

Methods

In 222 patients at risk of HCC who underwent both contrast-enhanced dynamic CT and gadoxetate disodium-enhanced MRI in 2017, 291 hepatic nodules ≤ 3.0 cm were retrospectively analyzed. Two radiologists performed image analysis and assigned a LI-RADS category to each nodule. The diagnostic performance for HCC was evaluated for CT, ordinary-MRI (washout confined to portal venous-phase), and modified-MRI (washout extended to hepatobiliary phase), and sensitivity and specificity were calculated for each modality. Generalized estimating equations were used to compare the diagnostic performance for HCC between combined CT and ordinary-MRI, combined CT and modified-MRI, and CT or MRI alone. p < 0.0062 (0.05/8) was considered statistically significant following Bonferroni correction for multiple comparisons.

Results

In 291 nodules, the sensitivity and specificity of CT, ordinary-MRI, and modified-MRI were 70.2% and 92.8%, 72.6% and 96.4%, and 84.6% and 88.0%, respectively. Compared with CT or MRI alone, both combined CT and ordinary-MRI (sensitivity, 83.7%; specificity, 95.2%) and combined CT and modified-MRI (sensitivity, 88.9%; specificity, 89.2%) showed significantly higher sensitivity (p ≤ 0.006), without a significant decrease in specificity (p ≥ 0.314).

Conclusions

Compared with CT or MRI alone, combined CT and MRI can increase sensitivity for diagnosing HCC ≤ 3.0 cm, without a significant decrease in specificity.

中文翻译：

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结合计算机断层扫描和磁共振成像改善肝细胞癌≤ 3.0 cm 的诊断

背景/目的

肝细胞癌 (HCC) 的影像诊断很重要，但使用肝脏影像报告和数据系统 (LI-RADS) v2018 的联合计算机断层扫描 (CT) 和磁共振成像 (MRI) 的诊断性能尚未完全了解。我们使用 LI-RADS 评估了 CT 和 MRI 联合诊断 HCC ≤ 3.0 cm 的临床有效性。

方法

在 2017 年接受对比增强动态 CT 和钆塞酸二钠增强 MRI 的 222 名有 HCC 风险的患者中，回顾性分析了 291 个≤ 3.0 cm 的肝结节。两名放射科医生进行了图像分析，并为每个结节分配了一个 LI-RADS 类别。通过 CT、普通 MRI（仅限于门静脉期的冲洗）和改良 MRI（冲洗扩展到肝胆期）评估 HCC 的诊断性能，并计算每种方式的敏感性和特异性。使用广义估计方程比较联合CT与普通MRI、联合CT与改良MRI、单独CT或MRI对HCC的诊断性能。 在多重比较的 Bonferroni 校正后，p < 0.0062 (0.05/8) 被认为具有统计学意义。

结果

在291个结节中，CT、普通MRI和改良MRI的敏感性和特异性分别为70.2%和92.8%、72.6%和96.4%、84.6%和88.0%。与单独 CT 或 MRI 相比，CT 联合普通 MRI（敏感性 83.7%；特异性 95.2%）和联合 CT 和改良 MRI（敏感性 88.9%；特异性 89.2%）均显示出显着更高的敏感性（p  ≤ 0.006)，特异性没有显着降低 ( p  ≥ 0.314)。

结论

与单独使用 CT 或 MRI 相比，联合 CT 和 MRI 可以提高诊断≤ 3.0 cm 的 HCC 的敏感性，而特异性没有显着降低。