Gadoxetic acid-based hepatobiliary MRI in hepatocellular carcinoma

钆酸 医学 肝细胞癌 磁共振成像 放射科 索拉非尼 临床终点 前瞻性队列研究 核医学 临床试验 内科学 钆DTPA
作者
Jens Ricke,Ingo G. Steffen,Irene Bargellini,Thomas Berg,José Ignacio Bilbao Jaureguízar,Bernhard Gebauer,Roberto Iezzi,Christian Loewe,Muşturay Karçaaltıncaba,Maciej Pech,Christian Sengel,Otto van Delden,Vincent Vandecaveye,Christoph J. Zech,Max Seidensticker
出处
期刊:JHEP reports [Elsevier BV]
卷期号:2 (6): 100173-100173 被引量:27
标识
DOI:10.1016/j.jhepr.2020.100173
摘要

SORAMIC is a prospective phase II randomised controlled trial in hepatocellular carcinoma (HCC). It consists of 3 parts: a diagnostic study and 2 therapeutic studies with either curative ablation or palliative Yttrium-90 radioembolisation combined with sorafenib. We report the diagnostic cohort study aimed to determine the accuracy of gadoxetic acid-enhanced magnetic resonance imaging (MRI), including hepatobiliary phase (HBP) imaging features compared with contrast-enhanced computed tomography (CT). The primary objective was the accuracy of treatment decisions stratifying patients for curative or palliative (non-ablation) treatment.Patients with clinically suspected HCC underwent gadoxetic acid-enhanced MRI (HBP MRI, including dynamic MRI) and contrast-enhanced CT. Blinded read of the image data was performed by 2 reader groups (radiologists, R1 and R2). A truth panel with access to all clinical data and follow-up imaging served as reference. Imaging criteria for curative ablation were defined as up to 4 lesions <5 cm and absence of macrovascular invasion. The primary endpoint was non-inferiority of HBP MRI vs. CT in a first step and superiority in a second step.The intent-to-treat population comprised 538 patients. Treatment decisions matched the truth panel assessment in 83.3% and 81.2% for HBP MRI (R1 and R2), and 73.4% and 70.8% for CT. Non-inferiority and superiority (second step) of HBP MRI vs. CT were demonstrated (odds ratio 1.14 [1.09-1.19]). HBP MRI identified patients with >4 lesions significantly more frequently than CT.In HCC, HBP MRI provided a more accurate decision than CT for a curative vs. palliative treatment strategy.Patients with hepatocellular carcinoma are allocated to curative or palliative treatment according to the stage of their disease. Hepatobiliary imaging using gadoxetic acid-enhanced MRI is more accurate than CT for treatment decision-making.
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