| Purpose : Taking contrast enhanced computer tomography(CT)as reference,to investigate the accuracy of Primovist-enhanced magnetic resonance imaging(MRI)in showing washout appearance of hepatic leisions in patients with different liver function grading of chronic liver disease,and the diagnostic accuracy of wastout apperance on the portal vein or transitional phase for typical hepatocellular carcinoma(HCC).Materials and Methods : Clinical and imaging data of patients suspected with hepatic lesions and having donecontrast enhanced CT and Primovist-enhanced MRI examination(time interval of two examinations less than 1 week)from November2015 to August 2018 were prospective collected and retrospective analyzed.According to liver function,the 318 patients were divided into three groups,Child-Pugh grade A(CPA)group(159 male,68 female,56.0±10.3 years),Child-Pugh grade B(CPB)group(45 male,23 female,56.3±10.3 years),and Child-Pugh grade C(CPC)group(159 male,68 female,53.6±11.8 years).Two radiologists with experience in abdominal system diagnosis and training in the Liver Imaging Reporting and Data Management System(LI-RADS)guidelines observed arterial phase enhancement,portal venous and delay or transitional wastout appearance of each lesion independently and blindly on the same workstation.A chief physician with 20 years of experience in the diagnosis of abdominal system performed a comprehensive clinical and imaging analysis of all hepatic lesions and characterized them as typical HCC or other lesion.One-way ANOVA or non-parametric Kruskal-Wallis test was used to compare the differences of age and nodule size among patients with different liver function grade.The Kappa test was used to analyze the intra-observer consistency for characterizing enhancement features of each hepatic lesions.The chi-square test or Fisher's exact probability method was used to compare the gender distribution among patients with different liver function grade,and the differences of washout appearance in portal vein and transitional or delay pahse for non-peripheral enhanced liver lesions in arterial phase in each liver function group between the two examnations methods.The Receiver operating characteristic(ROC)analysis was used to compare the diagnostic performance of non-peripheral arterial phase enhancement combined with washout appearance in portal vein and delayed or transitional phase for typical HCC of two examnations in different liver function groups.The De Long test was used to compare the differences of the value of Area under curve(AUC).Results:(1)In contrast enhanced CT,the proportion of washout appearance was lower on portal vein phase than on delay phase of hepatic lesions with non-peripheral enhanced on arterial phase enhancement in patients with CPA group and CPB group(P<0.01,P=0.021).For patients in CPC group,although the proportion of washout appearance on portal vein phase was lower than delay phase of hepatic lesions with non-peripheral enhanced on arterial phase,the difference was not statistically significant(P=0.398).(2)In Primovist-enhanced MRI,the proportion of washout appearance was lower on portal vein phase than on transitional phase of hepatic lesions with non-peripheral enhanced on arterial phase in CPA,CPB and CPC group(P < 0.01,P < 0.01,P=0.026).(3)For patients in CPA and CPC group,the proportion of washout appearance on portal vein phase of hepatic lesions with non-peripheral enhanced on arterial phase was lower in Primovist-enhanced MRI than contrast enhanced CT(P<0.01,P=0.0296).For patients in CPB group,although the proportion of washout appearance on portal vein phase of hepatic lesions with non-peripheral enhanced on arterial phase was lower in Primovist-enhanced MRI than contrast enhanced CT,the difference was not statistically significant(P=0.076).(4)For patients in CPA group,CPB group and CPC group,the proportion of washout appearance on transitional phase or delay phase of hepatic lesions with non-peripheral enhanced on arterial phaset was not statistically significan between with Primovist-enhanced MRI and contrast enhanced CT(P=0.178,P=1.000,P=1.000).(5)For patients in CPA,CPB and CPC group,there was no significant difference in the diagnosis accuracy of non-peripheral enhancement on arterial phase combined with washout appearance on portal vein phase for typical HCC between with Primovist-enhanced MRI and contrast enhanced CT(P=0.4494,P=0.3048,P=0.2586).(6)For patients in CPA,CPB and CPC group,there was no significant difference in the diagnosis accuracy of non-peripheral enhancement on arterial phase combined with washout appearance on transitional or delay phase for typical HCC between with Primovist-enhanced MRI and contrast enhanced CT(P=0.6709,P=0.3173,P=1.0000).(7)In contrast enhanced CT,for patients in CPA,CPB and CPC group,there was no significant difference in the diagnostic accuracy for typical HCC between non-peripheral enhancement on arterial phase combined with washout appearance on portal vein phase and on delay phase(P=0.1610,P=0.8965,P=0.0578).(8)In Primovist-enhanced MRI,for patients in CPA and CPB group,there was no significant difference in the diagnostic accuracy for typical HCC between non-peripheral enhancement on arterial phase combined with washout appearance on portal vein and on transitional phase(P=0.1724,P=0.5102),however,the sensitivity of the former(70.06%,74.47%)is lower than the latter(91.71%,93.61%),the specificity(82.40%,81.40%)is higher than the latter(53.60%,67.44%).For patients in CPC group,the diagnostic accuracy for typical HCC of non-peripheral enhancement on arterial phase combined with washout appearance on portal vein phase was significantly lower than on transitional phase(P=0.0152).Conclusions : Taking contrast enhanced CT as reference,portal venous phase and transitional phase in Primovist-enhanced MRI did not excessively show washout appearance for hepatic lesions in patients with chronic liver disease.For patients with liver function of CPA and CPB,portal venous phase was recommended to observe the washout appearance,for patients with liver function of CPC,transitional phase was recommended to observe the washout appearance to improve the diagnostic accuracy of HCC.However,for patients with high risk of HCC,transitional phase was recommended to observe the washout appearance to improve the sensitivity of HCC diagnosis for patients with liver function of CPA and CPB. |
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