Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Diagnostic Performance of Simulated Abbreviated MRI for Early-Stage Hepatocellular Carcinoma Screening: A Comparison to Conventional Dynamic Contrast-Enhanced MRI

초기 간암 선별 검사로서 단축 자기공명영상 검사의 진단능: 고식적 역동학적 자기공명영상검사와의 비교

  • Eun Sol Lim (Department of Radiology, Chonnam National University Hospital) ;
  • Sung Mo Kim (Department of Radiology, Chonnam National University Hospital) ;
  • Sang Soo Shin (Department of Radiology, Chonnam National University Hospital) ;
  • Suk Hee Heo (Department of Radiology, Chonnam National University, Hwasun Hospital) ;
  • Jong Eun Lee (Department of Radiology, Chonnam National University Hospital) ;
  • Yong Yeon Jeong (Department of Radiology, Chonnam National University, Hwasun Hospital)
  • 임은솔 (전남대학교병원 영상의학과) ;
  • 김성모 (전남대학교병원 영상의학과) ;
  • 신상수 (전남대학교병원 영상의학과) ;
  • 허숙희 (화순전남대학교병원 영상의학과) ;
  • 이종은 (전남대학교병원 영상의학과) ;
  • 정용연 (화순전남대학교병원 영상의학과)
  • Received : 2020.10.05
  • Accepted : 2020.10.30
  • Published : 2021.09.01
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Abstract

Purpose To compare the per-patient diagnostic performance of simulated abbreviated MRI (AMRI) to that of conventional MRI (CMRI) with full-sequence dynamic gadoxetic acid (GA) enhancement for early-stage hepatocellular carcinoma (HCC) screening in high-risk patients. Materials and Methods A total of 201 consecutive patients at high-risk for HCC, who underwent 3T liver MRI, were included in this retrospective study. The AMRI protocol comprised T2-weighted imaging, hepatobiliary phase imaging after GA injection, and diffusion-weighted imaging. For each patient, two AMRI and CMRI image sets were independently reviewed by two radiologists. Inter-reader agreement was assessed using Cohen's kappa value. A composite reference standard was used to determine the diagnostic performance of each image set for each reader. Results A total of 93 HCCs were detected in 79 patients. The inter-reader agreement was almost perfect for both image sets (κ = 0.839, 0.948). In AMRI, the per-patient sensitivity and negative predictive values (NPV) were 94.9% and 96.4%, respectively. In CMRI, the per-patient sensitivity and NPV were 96.2% and 97.5%, respectively. Conclusion AMRI, using only three sequences, had a comparable diagnostic performance to CMRI in screening early-stage HCC. AMRI could be an alternative HCC screening tool for high-risk HCC patients.

목적 고위험 환자에서 초기 간암 선별 검사로써 단축 자기공명영상 검사의 환자별 진단능을 기존의 고식적 간 자기공명영상검사와 비교하고자 한다. 대상과 방법 간암 고위험군에서 간 자기공명영상 검사를 시행 받은 총 201명의 환자에 대해 연구를 시행하였다. 단축 자기공명영상 검사 군의 프로토콜은 T2 강조영상, 담도기 T1 강조영상, 확산강조영상 등으로 구성되며, 두 명의 영상의학과 의사가 각각의 환자에 대해 후향적으로 단축 자기공명영상검사 군 및 고식적 자기공명영상검사 군, 두 군의 영상을 독립적으로 평가하였다. 두 연구자 간 일관성은 Cohen's kappa 값을 이용하여 비교하였다. 복합적인 참조표준을 이용하여 두 군에서 각각 진단능을 평가하여 비교하였다. 결과 79 명의 환자에서 총 93개의 간암이 발견되었다. 두 연구자 간 일관성은 두 군에서 모두 매우 양호하였다(κ = 0.839, 0.948). 단축 자기공명영상검사 군에서 민감도 및 음성예측도는 각각 94.9% 및 96.4%였으며, 이는 고식적 자기공명영상검사 군과 큰 차이를 보이지 않았다(96.2%, 97.5%). 결론 단축 자기공명영상검사는 고식적 자기공명영상검사에 비교하여 임상적으로 허용 가능한 민감도와 음성예측도를 갖는다. 따라서 간암 고위험군 환자에서 간암 선별검사로써 새로운 대안이 될 수 있을 것이다.

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