Yasuharu Imai1, Kazuhiro Katayama2, Masatoshi Hori3, Takayuki Yakushijin4, Kenji Fujimoto5,6, Toshifumi Itoh7, Takumi Igura1, Mitsuru Sakakibara2, Manabu Takamura8, Masakatsu Tsurusaki9, Hiroto Takahashi3, Katsuyuki Nakanishi10, Noriaki Usuki11, Koh Tsuji12, Hiroshi Ohashi13, Tonsok Kim3, Tetsuo Takehara4, Takamichi Murakami9. 1. Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan. 2. Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan. 3. Department of Radiology, Osaka University Graduate School of Medicine, Suita, Japan. 4. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan. 5. Department of Internal Medicine, National Hospital Organization Minamiwakayama Medical Center, Tanabe, Japan. 6. Division of Clinical Research, National Hospital Organization Minamiwakayama Medical Center, Tanabe, Japan. 7. Department of Gastroenterology and Hepatology, JCHO Osaka Hospital, Osaka, Japan. 8. Department of Radiology, Ikeda Municipal Hospital, Ikeda, Japan. 9. Department of Radiology, Faculty of Medicine, Kindai University, Sayama, Japan. 10. Department of Diagnostic Radiology, Osaka International Cancer Institute, Osaka, Japan. 11. Department of Radiology, JCHO Osaka Hospital, Osaka, Japan. 12. Department of Radiology, National Hospital Organization Minamiwakayama Medical Center, Tanabe, Japan. 13. Department of Pathology, Ikeda Municipal Hospital, Ikeda, Japan.
Abstract
BACKGROUND: We prospectively compared the efficacy of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) with that of dynamic multidetector computed tomography (MDCT) for detection of recurrent hypervascular hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). METHODS: Institutional review board approval and written informed consent were obtained for this multicenter study. Ninety-seven HCC patients treated with curative RFA underwent both Gd-EOB-DTPA-enhanced MRI and dynamic MDCT every 3-4 months. HCC diagnosis was made based on the typical enhancement pattern of HCC on MRI and/or CT by on-site consensus reading. Two blinded observers independently assessed image datasets to compare diagnostic accuracy, sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUROC). RESULTS: Recurrence was observed in 48 of 97 patients. Among these, 22 were diagnosed by both Gd-EOB-DTPA-enhanced MRI and MDCT; the remainder were diagnosed by only one of these 2 modalities. Recurrence was diagnosed in more patients by Gd-EOB-DTPA-enhanced MRI than by MDCT (44 vs. 26 patients, p < 0.001). Patient-based analysis revealed that the accuracy, sensitivity, and AUROC of Gd-EOB-DTPA-enhanced MRI were significantly higher than those of MDCT for both observers (p < 0.005). The AUROC of Gd-EOB-DTPA- enhanced MRI and MDCT was 0.95 and 0.76 for observer 1 and 0.90 and 0.74 for observer 2, respectively. The κ values for MRI and MDCT were 0.83 and 0.70, respectively. CONCLUSIONS: Compared with dynamic MDCT, Gd-EOB-DTPA-enhanced MRI had higher diagnostic accuracy and sensitivity for detection of recurrent hypervascular HCC and may be a better tool for following patients after RFA.
BACKGROUND: We prospectively compared the efficacy of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) with that of dynamic multidetector computed tomography (MDCT) for detection of recurrent hypervascular hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). METHODS: Institutional review board approval and written informed consent were obtained for this multicenter study. Ninety-seven HCC patients treated with curative RFA underwent both Gd-EOB-DTPA-enhanced MRI and dynamic MDCT every 3-4 months. HCC diagnosis was made based on the typical enhancement pattern of HCC on MRI and/or CT by on-site consensus reading. Two blinded observers independently assessed image datasets to compare diagnostic accuracy, sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUROC). RESULTS: Recurrence was observed in 48 of 97 patients. Among these, 22 were diagnosed by both Gd-EOB-DTPA-enhanced MRI and MDCT; the remainder were diagnosed by only one of these 2 modalities. Recurrence was diagnosed in more patients by Gd-EOB-DTPA-enhanced MRI than by MDCT (44 vs. 26 patients, p < 0.001). Patient-based analysis revealed that the accuracy, sensitivity, and AUROC of Gd-EOB-DTPA-enhanced MRI were significantly higher than those of MDCT for both observers (p < 0.005). The AUROC of Gd-EOB-DTPA- enhanced MRI and MDCT was 0.95 and 0.76 for observer 1 and 0.90 and 0.74 for observer 2, respectively. The κ values for MRI and MDCT were 0.83 and 0.70, respectively. CONCLUSIONS: Compared with dynamic MDCT, Gd-EOB-DTPA-enhanced MRI had higher diagnostic accuracy and sensitivity for detection of recurrent hypervascular HCC and may be a better tool for following patients after RFA.
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