Evaluation of Early-Stage Hepatocellular Carcinoma by Magnetic Resonance Imaging With Gadoxetic Acid Detects Additional Lesions and Increases Overall Survival

钆酸 肝细胞癌 阶段(地层学) 磁共振成像 医学 放射科 核磁共振 钆DTPA 内科学 物理 生物 古生物学
作者
Hyung-Don Kim,Young‐Suk Lim,Seungbong Han,Jihyun An,Gi‐Ae Kim,So Yeon Kim,So Jung Lee,Hyung Jin Won,Jae Ho Byun
出处
期刊:Gastroenterology [Elsevier BV]
卷期号:148 (7): 1371-1382 被引量:114
标识
DOI:10.1053/j.gastro.2015.02.051
摘要

Background & Aims

Hepatocellular carcinoma (HCC) has a high rate of intrahepatic recurrence after curative treatment, possibly because metastases are not always identified before treatment. Magnetic resonance (MR) imaging with a liver-specific contrast agent, gadoxetic acid, can detect small HCCs with high levels of sensitivity. We investigated whether MR imaging with gadoxetic acid increases overall and recurrence-free survival of patients initially assessed by computed tomography (CT).

Methods

We performed a retrospective study of data from 700 patients diagnosed with a single-nodular HCC by dynamic 4-phase CT in Seoul, Korea, from January 2009 through December 2010. Of these patients, 323 underwent additional evaluation with gadoxetic acid–enhanced MR imaging (CT+MR group). The 377 patients who did not undergo MR imaging analysis are referred to as the CT group.

Results

The CT and CT+MR groups were comparable in most baseline characteristics (Child–Pugh class A, 93.1% vs 94.7%; and median size of the primary HCCs, 2.8 vs 2.6 cm, respectively). Seventy-four additional HCC nodules were detected in 53 (16.4%) of the patients who underwent MR evaluation after CT (CT+MR group). These detections increased the Barcelona Clinic Liver Cancer stages for 43 patients (13.3%) and modified their treatment plans. On multivariable analyses, the CT+MR group had a significantly lower rate of HCC recurrence (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.54–0.96) and lower overall mortality (HR, 0.65; 95% CI, 0.44–0.96) than the CT group. In an analysis of 285 pairs of patients matched on the basis of the propensity score, the CT+MR group had significantly lower overall mortality (HR, 0.66; 95% CI, 0.44−0.99).

Conclusions

Among patients who underwent dynamic CT analysis of a single-nodular HCC, additional evaluation by MR imaging with gadoxetic acid led to the detection of additional HCC nodules in 16% of patients, reduced the risk of disease recurrence, and decreased overall mortality.
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