| Background and Objection:HEPATOCELLULAR CARCINOMA (HCC) is the most common primary liver cancer. The treatment of HCC includes surgical resection, liver transplantation and percutaneous transcatheter arterial chemoembolization (TACE), ablation therapy, molecular targeted therapy. However, most HCC lesions at the time of discovery have missed the opportunity to surgery, so the palliative treatment became more important in the treatment of HCC. Currently TACE combined with radiofrequency ablation (RFA) therapy has become a routine program HCC treatment been broadly recognized. According to the imaging features of the lesions to detect residual or recurrence tumor after TACE-RFA treatment, to determine the timing and extent of consolidation therapy is particularly significant for prognosis. RFA ablation necrotic areas under the various confounding factors cannot be fully ablation and lipiodol deposition also affects the diagnostic accuracy. It is very important to choose the highest diagnostic accuracy postoperative evaluation tool that can exclude confounding factors interference. Currently efficacy postoperative evaluation methods of HCC are in the following:Ultrasound diagnosis (BUD, CDFI, PDUS), computed tomography (CT), magnetic resonance imaging scan (MRI) digital subtraction angiography surgery (DSA). Among them, CT and MRI are the most widely used clinical tool to monitoring the efficacy of postoperative. Recently, gadoxetic acid (Gd-EOB-DTPA) has been used for the detection and characterization of focal hepatic lesions. It behaves as an extracellular agent in the early phase and as a hepatobiliary agent in the late phase, and may allow for accurate diagnosis based on hemodynamic and hepatocyte functions. Although there have been some studies that compared gadoxetic acid-enhanced MRI with MSCT for the detection of HCC, the diagnostic performance of gadoxetic acid-enhanced MRI for detection of HCC in patients after TACE-RFA is not yet fully established. To the best of our knowledge, there have been no comparative studies of gadoxetic acid-enhanced 3. OT MRI and MSCT for the evaluation of viable tumor of HCCs after TACE-RFA of HCCs. The purpose of our study, therefore, was to compare the diagnostic performance of gadoxetic acid-enhanced MRI with that of MSCT for the evaluation of viable tumors of HCCs treated with TACE-RFA therapy.Methods and materials51 consecutively registered patients with 88 HCCs underwent MSCT and gadoxetic acid enhanced 3-T MRI. Two observers independently and randomly reviewed the MR and CT images on a tumor-by-tumor basis. The diagnostic accuracy of these techniques in the detection of HCC was assessed with alternative free response receiver operating characteristic (ROC) analysis. Sensitivity, positive and negative predictive values, and sensitivity according to tumor size were evaluated. The ROC analysis of all lesions was performed tumor by tumor on the basis of reviews by the three observers. The area under the ROC curve (Az) was used to assess the diagnostic accuracy of each observer and technique and to perform statistical analysis. The sensitivity of each observer and technique was determined by the number of lesions assigned confidence level of 3 or 4 among the 83 HCCs. The sensitivity for each observer and technique was calculated, and the statistical analysis for differences of the sensitivities was performed with the McNemar test. Statistical analyses for the differences of calculated positive and negative predictive values for each observer and technique were based on a previous report. A value of p< 0.05 was considered to indicate a statistically significant difference. The tumors were categorized by size on the basis of fail standard of reference. An analysis of all false positive and false-negative observations also was undertaken. Kappa statistics were used to assess interobserver agreement in the detection of HCC with each technique. The degree of agreement was categorized as follows:Kappa values of 0.00-0.20were considered to indicate poor agreement; 0.21-0.40, fair agreement; 0.41-0.60, moderate agreement; 0.61-0.80, good agreement; and 0.81-1.00, excellent agreement.Results:The group of patients 5-6 weeks after TACE-RFA hepatic artery DSA conventional angiography, postoperative residual or recurrent tumor was found, new lesions TACE treatment again be based on the patient’s condition. The patients were followed up for 6.3 ±0.5 months for CT /MRI and DSA cannot be diagnosed with nodules were diagnosed by the late follow-up test or biopsy. In this study, patients were followed and eventually incorporated into complete GD-EOB-DTPA enhanced MRI,51 patients in two MSCT imaging found and treated HCC lesion number 88, underwent sequential TACE-RFA treatment, surgery After follow-up confirmed the presence of residual tumor recurrence total number of 47 (53.4%), no residual, recurrent lesions number 41 (46.6%). Reader 1 MSCT discrimination results:positive 54 and negative 34; Reader 2 MSCT discrimination results:positive 49 and negative 39; for MSCT examination, Kappa who read the piece between the two is 0.743±0.072 (p<0.05); Readerl GD-EOB-DTPA-enhanced MRI discrimination results: positive 50 and negative 38; Reader 2 GD-EOB-DTPA-enhanced MRI discrimination results:positive 50 and negative 38; for MSCT examination, two reading Kappa values between slices were 0.907±0.045 (p<0.05); Reader 1, Reader 2 Between GD-EOB-DTPA enhanced MRI, MSCT with high consistency on two imaging judge. Reader 1 in GD-EOB-DTPA enhanced sensitivity of MRI group was 96%(45/47), specificity was 88%(36/41), the positive predictive value of 90%(45/50), and negative predictive value 95%(36/38); Reader 1 in the sensitivity of MSCT group was 68% (32/47), specificity was 95%(39/41), the positive predictive value of 94%(32/34), and negative predictive value of 72%(39/54); MRI on postoperative residual/recurrent lesion diagnostic sensitivity and negative predictive value superior to MSCT (p= 0.001, p= 0.006), but the specificity and positive predictive diagnosis in values there was no significant difference (p> 0.05). Reader 2 in GD-EOB-DTPA enhanced sensitivity of MRI group was 91%(43/47), specificity was 83%(34/41), the positive predictive value of 86%(43/50), and negative predictive value 89%(34/38); Reader 2 in the sensitivity of MSCT group was 64% (30/47), specificity was 78%(32/41), the positive predictive value of 77%(30/39), and negative predictive value of 65%(32/49); MRI on postoperative residual/recurrent lesion diagnostic sensitivity and negative predictive value superior to MSCT (p= 0.002, p= 0.008), but the specificity and positive predictive diagnosis in values there was no significant difference (p> 0.05). Totality (readerl and reader2) MRI group was 94% sensitivity (88/94), specificity was 85%(70/82), the positive predictive value of 88%(88/100), and negative predictive value of 92%(70/76); the sensitivity of MSCT group was 66%(62/94), specificity was 87%(71/82), the positive predictive value of 56%(62/73), and negative predictive value of 69%(71/103); MRI on postoperative residual/recurrent lesion diagnostic sensitivity and negative predictive value superior to MSCT (<0.001), no significant difference (p in the diagnostic specificity and positive predictive values of both) 0.05). By ROC curve analysis, the next Reader 1 MRI ROC curve areas Area (Az)= 0.9856 (Std. Err= 0.0104; 95% CI 0.9485,0.9970); MSCT:the area under the ROC curve Area (Az)= 0.8983 (Std. Err=0.0349; 95% CI 0.8123, 0.9513). Differences area estimation under two ROC curve is 2.3959 (p =0.0166). By Reader 2 MRI ROC curve areas Area (Az)=0.9707 (Std. Err =0.0161; 95% CI 0.9219,0.990); MSCT ROC area under the curve Area (Az) = 0.8443 (Std. Err-0.0431; 95% CI 0.7449,0.9140). Differences area estimation under two ROC curve is 2.7449 (p= 0.0061). Under the overall MRI ROC curve areas Area (Az)= 0.9785 (Std. Err=0.0094; 95% CI 0.9522, 0.9913); area under the curve MSCT ROC Area (Az)=0.8688 (Std.Err= 0.0280; 95% CIO.8059,0.9160). Differences area estimation under two ROC curve is 3.7105 (p= 0.0002).ConclusionIn summary, this study compare the diagnostic performance of gadoxetic acid-enhanced MRI with that of multi-phase multidetector row computed tomography (MSCT) to evaluate viable tumors of hepatocellular carcinomas (HCCs) after treated with TACE-RFA, the results show that the combination therapy after TACE-RFA HCC lesions the postoperative patients, Gd-EOB-DTPA-enhanced MRI is more conducive to detection and diagnosis the residual or recurrent HCC lesions. Gadoxetic acid-enhanced MRI shows better diagnostic performance than that of MSCT for evaluating the viable tumors of HCCs treated with TACE-RFA therapy. |
PDF Full Text Request