Evaluation of Early-Stage Hepatocellular Carcinoma by Magnetic Resonance Imaging With Gadoxetic Acid Detects Additional Lesions and Increases Overall Survival
- Authors
- Kim, Hyung-Don; Lim, Young-Suk; Han, Seungbong; An, Ji hyun; Kim, Gi-Ae; Kim, So Yeon; Lee, So Jung; Won, Hyung Jin; Byun, Jae Ho
- Issue Date
- Jun-2015
- Publisher
- W B SAUNDERS CO-ELSEVIER INC
- Keywords
- BCLC; Gadoxetic Acid; Liver Cancer; Combined Image Analyses
- Citation
- GASTROENTEROLOGY, v.148, no.7, pp.1371 - 1382
- Indexed
- SCIE
SCOPUS
- Journal Title
- GASTROENTEROLOGY
- Volume
- 148
- Number
- 7
- Start Page
- 1371
- End Page
- 1382
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/156962
- DOI
- 10.1053/j.gastro.2015.02.051
- ISSN
- 0016-5085
- Abstract
- 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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