Objective
This study was conducted in order to compare the diagnostic performance of noncontrast and abbreviated MRI using gadoxetic acid for detecting hepatocellular carcinoma (HCC) in initially ...diagnosed HCC patients.
Methods
We identified 140 consecutive patients with newly diagnosed HCC (173 HCCs) within the Milan criteria, who underwent liver MRI using gadoxetic acid between 2015 and 2016. One hundred twenty-three consecutive patients without HCC who underwent liver MRI in the same period for HCC surveillance were enrolled for the control group. Two radiologists independently reviewed two MRI sets: a noncontrast set and an abbreviated set. The noncontrast set consists of T2 FSE/ssFSE, T1 in- and out-of-phase image, DWI, and the ADC map. The abbreviated set consists of T2 FSE/ssFSE, hepatobiliary phase image 20 min after gadoxetic acid injection, DWI, and the ADC map.
Results
In a per-patient analysis, sensitivity of reviewer 1 for noncontrast and abbreviated sets was 85.7 and 90.0%, respectively. The specificity for both noncontrast and abbreviated sets was 92.7%. For reviewer 2, sensitivity of noncontrast and abbreviated sets was 86.4 and 89.3%, respectively. Per-patient specificity of reviewer 2 was 92.7% for both noncontrast and abbreviated sets. The sensitivity and specificity of two image sets were not significantly different for both reviewers. The per-tumor sensitivity of noncontrast and abbreviated sets was 81.5 and 84.4% for reviewer 1, respectively, and 79.8 and 84.4% for reviewer 2, respectively. There was no significant difference.
Conclusion
Noncontrast and abbreviated MRI using gadoxetic acid showed comparable diagnostic performance for detecting patients with HCCs in the early stage.
Key Points
• Diagnostic performance of noncontrast MRI and abbreviated MRI using gadoxetic acid for detecting HCCs is comparable in patients with HCCs in the early stage.
• Noncontrast MRI and abbreviated MRI showed high sensitivity and specificity for detecting HCCs in the early stage.
• Outcomes of surveillance for HCC in high-risk patients can be improved by adopting these simplified and focused MRI protocols.
We prospectively investigated the association between a change of serum vascular endothelial growth factor (VEGF) level after transcatheter arterial chemoembolization (TACE) and hepatocellular ...carcinoma (HCC) patient prognosis. The study involved 147 patients with unresectable HCC treated at the National Cancer Center, Korea, between July and December 2005. Serum samples were collected from each patient before TACE, and 1–2 days and 1 month after TACE. Serum VEGF concentrations were measured using an enzyme‐linked immunosorbent assay (ELISA). The loge(VEGF/platelets) increased transiently 1–2 days after TACE and declined thereafter. Frequency of previous TACE did not correlate with loge(VEGF/platelets). This study found that loge(VEGF/platelets) 1–2 days after TACE, but not loge(VEGF/platelets) at baseline, was strongly correlated with vascular or nodal invasion and AJCC (American Joint Committee on Cancer)/UICC (International Union Against Cancer) stage, and was significantly greater in men. Relative changes in serum VEGF/platelet levels 1–2 days after TACE (ΔVEGF) > 0.5 were directly correlated with tumor size, vascular invasion and modified UICC and AJCC/UICC stage (P < 0.05 for each). Additionally, ΔVEGF > 0.5 was significantly correlated with newly developed extrahepatic metastases one and six months after TACE (P = 0.005 and 0.003, respectively). Progression free survival of patients with ΔVEGF > 0.5 was significantly worse (P < 0.001) and ΔVEGF > 0.5 was an independent prognostic factor for PFS (hazard ratio, 3.111; P < 0.001). This study showed that a high increment in serum VEGF level 1–2 days after TACE in HCC patients was associated with distant metastasis and unfavorable outcomes. (Cancer Sci 2008; 99: 2037–2044)
Purpose
To investigate the usefulness of apparent diffusion coefficient (ADC) values derived from histogram analysis of the whole rectal cancer as a quantitative parameter to evaluate pathologic ...complete response (pCR) on preoperative magnetic resonance imaging (MRI).
Materials and Methods
We enrolled a total of 86 consecutive patients who had undergone surgery for rectal cancer after neoadjuvant chemoradiotherapy (CRT) at our institution between July 2012 and November 2014. Two radiologists who were blinded to the final pathological results reviewed post‐CRT MRI to evaluate tumor stage. Quantitative image analysis was performed using T2‐weighted and diffusion‐weighted images independently by two radiologists using dedicated software that performed histogram analysis to assess the distribution of ADC in the whole tumor.
Results
After surgery, 16 patients were confirmed to have achieved pCR (18.6%). All parameters from pre‐ and post‐CRT ADC histogram showed good or excellent agreement between two readers. The minimum, 10th, 25th, 50th, and 75th percentile and mean ADC from post‐CRT ADC histogram were significantly higher in the pCR group than in the non‐pCR group for both readers. The 25th percentile value from ADC histogram in post‐CRT MRI had the best diagnostic performance for detecting pCR, with an area under the receiver operating characteristic curve of 0.796.
Conclusion
Low percentile values derived from the ADC histogram analysis of rectal cancer on MRI after CRT showed a significant difference between pCR and non‐pCR groups, demonstrating the utility of the ADC value as a quantitative and objective marker to evaluate complete pathologic response to preoperative CRT in rectal cancer. J. Magn. Reson. Imaging 2016;44:212–220.
Gastric cancer is one of the most common and fatal cancers.The importance of accurate staging for gastric cancer has become more critical due to the recent introduction of less invasive treatment ...options,such as endoscopic mucosal resection or laparoscopic surgery.The tumor-node-metastasis staging system is the generally accepted staging system for predicting the prognosis of patients with gastric cancer.Multidetector row computed tomography(MDCT)is a widely accepted imaging modality for the preoperative staging of gastric cancer that can simultaneously assess locoregional staging,including the gastric mass,regional lymph nodes,and distant metastasis.The diagnostic performance of MDCT for T-and N-staging has been improved by the technical development of isotropic imaging and 3D reformation.Although magnetic resonance imaging(MRI)was not previously used to evaluate gastric cancer due to the modality’s limitations,the development of high-speed sequences has made MRI a feasible tool for the staging of gastric cancer.
Purpose
To determine the inter-reader agreement of abbreviated magnetic resonance imaging (AMRI) for the detection of hepatocellular carcinoma (HCC) and explore the causes of heterogeneity between ...the reported results.
Methods
Original studies reporting the inter-reader agreement of AMRI for detecting HCC were identified in MEDLINE, EMBASE, and Cochrane databases. The pooled kappa coefficient (κ) was calculated using the DerSimonian–Laird random-effects model. Subgroup analyses were performed according to the AMRI protocol (non-contrast NC-AMRI, dynamic contrast-enhanced DCE-AMRI, and hepatobiliary phase HBP-AMRI). Meta-regression analyses were performed to further explore study heterogeneity.
Results
In the eight included studies (1182 patients), the overall pooled κ was 0.76 (95% confidence interval CI, 0.70–0.82;
I
2
= 74.4%). The κ of NC-AMRI, DCE-AMRI, and HBP-AMRI were 0.72 (95% CI, 0.62–0.82), 0.80 (95% CI, 0.78–0.82), and 0.98 (95% CI, 0.95–1.00), respectively. In the NC-AMRI, the pooled κ of NC-AMRI using only diffusion-weighted imaging (DWI) was 0.64, which was lower than the values using two or more imaging sequences (κ = 0.74–0.77). In subgroup analysis, no study heterogeneity was noted in studies using DCE-AMRI (
I
2
= 0%), whereas high heterogeneity was noted with NC-AMRI (
I
2
= 80.5%). Especially, NC-AMRI including more than two imaging sequences showed high residual heterogeneity (
I
2
= 87.6%). Meta-regression analysis found that difference in reader experience was significantly associated with study heterogeneity (
p
= .02).
Conclusion
AMRI for detecting HCC showed substantial inter-reader agreement across all examined protocols. NC-AMRI, notably NC-AMRI using only DWI, had relatively low inter-reader agreement. Therefore, DCE-AMRI or HBP-AMRI may be more reliable than NC-AMRI using only DWI.
Graphic abstract
Objectives
To compare the prognosis of pancreatic ductal adenocarcinoma (PDAC) after curative resection according to the type of intratumoral fluid–containing area identified on MRI.
Methods
This ...retrospective study included 112 consecutive patients who underwent upfront surgery with margin-negative resection between 2012 and 2019. All patients underwent MRI within 1 month before surgery. Three radiologists independently assessed the MRI findings, determined whether intratumoral fluid–containing areas were present, and classified all intratumoral fluid-containing areas by type (i.e., imaging necrosis or neoplastic mucin cysts). Recurrence-free survival (RFS) and overall survival (OS) were evaluated by the Kaplan–Meier method and the Cox proportional hazards model. Histopathological differences according to the type of intratumoral fluid–containing area were assessed.
Results
Of the 112 PDAC patients, intratumoral fluid–containing areas were identified on MRI in 33 (29.5%), among which 18 were classified as imaging necrosis and 15 as neoplastic mucin cysts. PDAC patients with imaging necrosis demonstrated significantly shorter RFS (mean 6.1 months versus 47.3 months;
p
< .001) and OS (18.4 months versus 55.0 months,
p
= .001) than those with neoplastic mucin cysts. Multivariable analysis showed that only the type of intratumoral fluid–containing area was significantly associated with RFS (hazard ratio, 2.25 and 0.38;
p
= .009 and
p
= .046 for imaging necrosis and neoplastic mucin cysts, respectively). PDAC with imaging necrosis had more frequent histological necrosis, more aggressive tumor differentiation, and higher tumor cellularity than PDAC with neoplastic mucin cysts (
p
≤ .02).
Conclusion
The detection and discrimination of intratumoral fluid–containing areas on preoperative MRI may be useful in predicting the prognosis of PDAC patients after curative resection.
Key Points
• Pancreatic ductal adenocarcinoma (PDAC) patients with imaging necrosis demonstrated significantly shorter survival than those with neoplastic mucin cysts after curative resection.
• Multivariable analysis showed that only the type of intratumoral fluid–containing area identified on MRI was significantly associated with recurrence-free survival.
• PDAC with imaging necrosis had more frequent histological necrosis, more aggressive tumor differentiation, and higher tumor cellularity than PDAC with neoplastic mucin cysts.
Purpose
To assess the association between T2-weighted imaging (T2WI) texture-analysis parameters and the pathological aggressiveness or long-term outcomes in pancreatic ductal adenocarcinoma (PDAC) ...patients.
Methods
A total of 66 patients (mean age 65.3 ± 9.0 years) who underwent preoperative MRI followed by pancreatectomy for PDAC between 2013 and 2015 were included in this study. A radiologist performed a texture analysis twice on one axial image using commercial software. Differences in the tex parameters, according to pathological factors, were analyzed using a Student’s
t
test or an ANOVA with Tukey’s test. Univariate and multivariate Cox proportional hazards regression analyses were used to evaluate the association between tex parameters and recurrence-free survival (RFS) or overall survival (OS).
Results
The mean follow-up time was 18.5 months, and there were 58 recurrences and 39 deaths. The mean of the positive pixel (MPP)-related factors was significantly lower in poorly differentiated tumors than in well-differentiated tumors as well as in cases with perineural invasion. The univariate Cox proportional hazards analysis showed a significant association between the tex parameters and RFS or OS. However, only tumor size was statistically significant after the multivariate analysis. Only tumor size and entropy with medium texture were significantly associated with OS after the multivariate analysis.
Conclusions
Tumor size was a significant predictive factor for RFS and OS in PDAC patients. Although entropy with medium texture analysis was significantly associated with OS, there were also limitations in the texture analysis; thus, further study is necessary.
Objective
To systematically determine the accuracy of Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm for diagnosing the viability of hepatocellular carcinoma (HCC) ...treated with locoregional therapy (LRT).
Methods
Original studies reporting the diagnostic accuracy of LR-TR algorithm on dynamic contrast-enhanced computed tomography or magnetic resonance imaging (MRI) were identified in MEDLINE and EMBASE up to June 1, 2020. The meta-analytic summary sensitivity and specificity of LR-TR algorithm were calculated using a bivariate random-effects model. Subgroup analyses and meta-regression analysis were performed to explore study heterogeneity.
Results
We found six studies reporting the accuracy of LR-TR viable category (601 observations in 453 patients). The meta-analytic pooled sensitivity and specificity of LR-TR viable category were 63% (95% confidence interval CI, 39–81%;
I
2
= 88%) and 96% (95% CI, 91–99%;
I
2
= 76%), respectively. The meta-analytic pooled sensitivity and specificity of LR-TR viable or equivocal category combined were 71% (95% CI, 55–84%;
I
2
= 89%) and 87% (95% CI, 73–94%
I
2
= 80%), respectively. Studies which used only MRI showed a trend towards higher sensitivity (71% 95% CI, 46–88%) with a comparable specificity (95% 95% CI, 86–99%) of LR-TR viable category compared to the whole group. The type of reference standard and study design were significantly associated with study heterogeneity (
p
≤ 0.01).
Conclusions
The LR-TR viable category had high specificity but suboptimal sensitivity for diagnosing the viability of HCC after LRT. Substantial study heterogeneity was noted, and it was significantly associated with the type of reference standard and study design.
Key Points
•
The meta-analytic pooled sensitivity and specificity of LR-TR viable category were 63% (95% CI, 39–81%) and 96% (95% CI, 91–99%), respectively
.
•
The meta-analytic pooled sensitivity and specificity of LR-TR viable or equivocal category combined were 71% (95% CI, 55–84%) and 87% (95% CI, 73–94%), respectively
.
•
The type of reference standard and study design were the factors significantly influencing study heterogeneity (p ≤ 0.01)
.
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