Diagnostic accuracy of different magnetic resonance imaging sequences for detecting local tumor progression after radiofrequency ablation of hepatic malignancies

作者：Weiss Jakob; Rempp Hansjoerg; Clasen Stephan; Notohamiprodjo Mike; Kessler David Emanuel; Pereira Philippe L; Blumenstock Gunnar; Nikolaou Konstantin; Hoffmann Ruediger

来源：European Journal of Radiology, 2017, 94: 85-92.

DOI：10.1016/j.ejrad.2017.06.009

• Diagnostic accuracy
• Magnetic resonance imaging
• Radiofrequency ablation
• Hepatic malignancies
• Local tumour progression
• Imaging pitfalls

Objective: To evaluate the diagnostic accuracy of the individual sequences of a clinical routine liver MRI protocol for the detection of local tumour progression after radiofrequency (RF) ablation of hepatic malignancies.
Material and methods: A cohort of 93 patients treated for 140 primary and secondary hepatic malignancies with RF ablation was assembled for this retrospective study. The cohort contained 31 cases of local tumour progression, which occurred 8.3 +/- 6.2 months (range: 4.0-28.2 months) after treatment. All patients underwent clinical routine follow-up MRI at 1.5T including following sequences: unenhanced T1-weighted fast low angle shot (FLASH-2D), T2-weighted turbo-spin-echo sequence, contrast-enhanced (CE) T1-weighted volume-interpolated breath-hold examination (VIBE), diffusion-weighted imaging (DWI). Follow-up was 32.7 +/- 22.5 months (range: 4.0-138.3 months). Two readers independently evaluated the individual sequences separately for signs of local tumour progression. Diagnostic confidence was rated on a 4-point scale. Inter-reader agreement was assessed with Cohens kappa. Long-term follow-up and histological specimen served as standard of reference.
Results: Both readers reached the highest sensitivity for detection of local tumour progression with unenhanced T1-FLASH 2D (88.2% and 94.1%, respectively) and the highest specificity with CE T1-VIBE (96.2% and 97.2%, respectively). Highest inter-reader agreement was reached with T1-FLASH-2D (kappa = 0.83). Typical pitfalls for false-positive diagnoses were focal cholestasis and vasculature adjacent to the ablation zone. Diagnostic confidence was highest with CE T1-VIBE for reader 1 and DWI for reader 2.
Conclusion: Unenhanced T1-FLASH-2D is an essential sequence for follow-up imaging after tumour ablation with a high sensitivity for detection of local progression and a high inter-reader agreement.

• 出版日期2017-9