Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Value of Image Subtraction for the Identification of Hepatocellular Carcinoma Capsule on Gadoxetic Acid-Enhanced MRI

가도세틱산-조영증강 MRI에서 간세포암 피막 발견에 대한 영상차감기법의 진단적 가치

  • Kim, Hyunjung (Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital) ;
  • Ahn, Jhii-Hyun (Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital) ;
  • Moon, Jin Sil (Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital) ;
  • Cha, Seung-Whan (Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital)
  • 김현중 (연세대학교 원주의과대학 원주세브란스 기독병원 영상의학과) ;
  • 안지현 (연세대학교 원주의과대학 원주세브란스 기독병원 영상의학과) ;
  • 문진실 (연세대학교 원주의과대학 원주세브란스 기독병원 생의학데이터센터) ;
  • 차승환 (연세대학교 원주의과대학 원주세브란스 기독병원 영상의학과)
  • Received : 2017.11.16
  • Accepted : 2018.11.17
  • Published : 2018.12.01
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Abstract

Purpose: To evaluate value of image subtraction for identifying hepatocellular carcinoma (HCC) capsule on gadoxetic acid-enhanced MR images. Materials and Methods: This study involved 108 patients at risk of HCC preoperatively examined using gadoxetic acid-enhanced MRI with hepatic resection between May 2015 and February 2017. We evaluated qualities of subtraction images and presence of capsular appearance on portal venous or transitional phases conventional and subtraction images. We assessed effect of capsular appearance on subtraction images on HCC. Results: After excluding 1 patient who had treated by transarterial chemoembolization prior to surgery and 33 patients with unsatisfactory subtraction image qualities, 82 focal hepatic lesions (73 HCC, 5 non-HCC malignancies, and 4 benign) from 74 patients were analyzed. Regarding detection of capsules, sensitivity, accuracy, and area under the receiver operating characteristic curve (AUC) on subtraction images were significantly higher than those on conventional images (95.4%, 89.0%, and 0.80, respectively; p < 0.001), though specificities were same (64.7%). For diagnosis of HCC, sensitivity, accuracy, and AUC on subtraction images were significantly higher than on conventional images (82.2%, 79.3%, and 0.69, respectively; p = 0.011), though specificities were identical (55.6%). Conclusion: Portal venous or transitional phase gadoxetic acid-enhanced MRI subtraction images could improve detection of HCC capsule.

목적: 가도세틱산-조영증강 MRI에서 간세포암 피막 발견에 대한 영상차감기법의 진단적 가치를 알아보고자 하였다. 대상과 방법: 2015년 5월부터 2017년 2월까지 가도세틱산-조영증강 MRI를 시행 받고 수술을 시행한 hepatocellular carcinoma (이하 HCC) 고위험군 108명을 대상으로 하였다. 차감영상의 질 및 간문맥기와 이행기의 일반영상과 차감영상에서 피막 여부에 대해 평가하였고, 차감영상에서의 피막 여부가 Liver Imaging Reporting and Data System에 따른 간세포암 진단에 미치는 영향을 평가하였다. 결과: 수술 전 경동맥화학색전술을 시행 받았거나 차감영상의 질이 불만족스러운 34명의 환자를 제외한 74명의 환자에서 82개의 간 병변(간세포암 73개, 그 외 악성종양 5개, 양성종양 4개)에 대해 분석하였다. 피막의 발견에 대한 차감영상의 민감도, 정확도, 그리고 곡선하면적은 일반영상과 비교하여 통계적으로 유의하게 높았고(각 95.4%, 89.0%, 0.80; p < 0.001), 특이도는 동일하였다(64.7%). HCC의 진단에 대해서도 차감영상이 일반영상과 비교하여 민감도, 정확도, 그리고 곡선하면적이 통계적으로 유의하게 높았으며(각 82.2%, 79.3%, 0.69; p = 0.011), 특이도는 동일하였다(55.6%). 결론: 가도세틱산-조영증강 MRI에서 간문맥기 또는 이행기로부터의 차감영상은 간세포암 피막의 발견에 도움이 된다.

Keywords

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