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최준일Joon-Il Choi
가톨릭대학교 의과대학 서울성모병원
Liver Cancer, Apr 22 2025, | https://doi.org/10.1159/000545965
Comparison of Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging and Contrast-Enhanced Computed Tomography for the Noninvasive Diagnosis of Hepatocellular Carcinoma
Jeong Hee Yoona,b, Won Changb,c, Young Kon Kimd, Chang Hee Leee, Jeong Woo Kime, Beom Jin Parkf, Jin-Young Choig, Seung-seob Kimg, Hee Sun Parkh, Eun Sun Leei, Jeong-Sik Yuj, Seong Jin Parkk, Myung-Won Youk, Myoung-jin Jangl, Joon-Il Choim, Jeong Min Leea,b,n
aDepartment of Radiology, Seoul National University Hospital, Seoul, Republic of Korea;
bDepartment of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea;
cDepartment of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea;
dDepartment of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;
eDepartment of Radiology, Korea University Guro Hospital and College of Medicine, Seoul, Republic of Korea;
fDepartment of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea;
gDepartment of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea;
hDepartment of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea;
iDepartment of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea;
jDepartment of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea;
kDepartment of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea;
lMedical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea;
mDepartment of Radiology, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;
nInstitute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
Jeong Hee Yoon and Won Chang are co-first authors.
Correspondence to: Joon-Il Choi, Jeong Min Lee
aDepartment of Radiology, Seoul National University Hospital, Seoul, Republic of Korea;
bDepartment of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea;
cDepartment of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea;
dDepartment of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;
eDepartment of Radiology, Korea University Guro Hospital and College of Medicine, Seoul, Republic of Korea;
fDepartment of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea;
gDepartment of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea;
hDepartment of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea;
iDepartment of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea;
jDepartment of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea;
kDepartment of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea;
lMedical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea;
mDepartment of Radiology, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;
nInstitute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
Jeong Hee Yoon and Won Chang are co-first authors.
Correspondence to: Joon-Il Choi, Jeong Min Lee
Abstract
Introduction: Magnetic resonance imaging (MRI) has been shown to outperform computed tomography (CT) in diagnosing hepatocellular carcinoma (HCC), although inconsistencies exist across studies. We compared the performance of CT and gadoxetic acid-enhanced MRI in diagnosing HCC according to various guidelines, and to assess the incremental value of a second-line examination.
Methods: This retrospective multicenter study included patients at risk of developing HCC with focal liver lesions (FLLs) ≥10 mm. These patients underwent both contrast-enhanced CT and gadoxetic acid-enhanced MRI between January 2015 and June 2018. Four radiologists independently assessed the images using criteria from the Liver Imaging Reporting and Data System (LI-RADS), the Asian Pacific Association for the Study of the Liver (APASL), and the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) guidelines. The diagnostic performance of CT and MRI was compared across guidelines.
Results: In total, 1,590 FLLs (median size, 22.6 mm) were analyzed in 1,455 patients (median age, 59 years; male, 1,101). Sensitivity was higher with MRI than with CT for APASL (89.3% [95% CI: 87.7%, 90.8%] vs. 78.9% [95% CI: 77.0%, 80.8%], respectively) and KLCA-NCC (78.7% [95% CI: 76.7%, 85.0%] vs. 73.7% [95% CI: 71.6%, 75.7%], respectively) (p = 0.002 for both). However, LI-RADS showed lower sensitivity with MRI than with CT (70.6% [95% CI: 68.4%, 72.6%] vs. 74.7% [95% CI: 72.6%, 76.7%], p = 0.002), due to fewer nonperipheral washout. MRI re-categorized 22.4%, 32.2%, and 53.5% of non-HCC observations on CT as HCC with LI-RADS, KLCA-NCC, and APASL, respectively. CT re-classified 30.2%, 29.0%, and 25.8% of non-HCC observations on MRI as HCC with LI-RADS, KLCA-NCC, and APASL, respectively.
Conclusion: The added value of gadoxetic acid-enhanced MRI after CT depends on the diagnostic criteria used. Restricting washout timing to the portal venous phase in LI-RADS reduces the sensitivity of gadoxetic acid-enhanced MRI relative to CT.
Methods: This retrospective multicenter study included patients at risk of developing HCC with focal liver lesions (FLLs) ≥10 mm. These patients underwent both contrast-enhanced CT and gadoxetic acid-enhanced MRI between January 2015 and June 2018. Four radiologists independently assessed the images using criteria from the Liver Imaging Reporting and Data System (LI-RADS), the Asian Pacific Association for the Study of the Liver (APASL), and the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) guidelines. The diagnostic performance of CT and MRI was compared across guidelines.
Results: In total, 1,590 FLLs (median size, 22.6 mm) were analyzed in 1,455 patients (median age, 59 years; male, 1,101). Sensitivity was higher with MRI than with CT for APASL (89.3% [95% CI: 87.7%, 90.8%] vs. 78.9% [95% CI: 77.0%, 80.8%], respectively) and KLCA-NCC (78.7% [95% CI: 76.7%, 85.0%] vs. 73.7% [95% CI: 71.6%, 75.7%], respectively) (p = 0.002 for both). However, LI-RADS showed lower sensitivity with MRI than with CT (70.6% [95% CI: 68.4%, 72.6%] vs. 74.7% [95% CI: 72.6%, 76.7%], p = 0.002), due to fewer nonperipheral washout. MRI re-categorized 22.4%, 32.2%, and 53.5% of non-HCC observations on CT as HCC with LI-RADS, KLCA-NCC, and APASL, respectively. CT re-classified 30.2%, 29.0%, and 25.8% of non-HCC observations on MRI as HCC with LI-RADS, KLCA-NCC, and APASL, respectively.
Conclusion: The added value of gadoxetic acid-enhanced MRI after CT depends on the diagnostic criteria used. Restricting washout timing to the portal venous phase in LI-RADS reduces the sensitivity of gadoxetic acid-enhanced MRI relative to CT.
논문정보
- Research article
- 2025년 04월 (BRIC 등록일 2025-06-10)
- 국내 연구진
- 의약학 > 종양의학
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