Abstract：
OBJECTIVE: The study aims at assessing the quantitative features which distinguish focal liver lesions (FLLs) in gadoxetic acid (GA) enhanced liver MRI and at determining whether these features can accurately differentiate benign from malignant lesions.
METHODS: 107 patients with 180 unequivocal FLLs in previous examinations were included in a single-center retrospective study. All patients underwent a MRI test of the liver with GA. 99 benign and 74 malignant lesions were included. The group of benign lesions consisted of 60 focal nodular hyperplasias (FNH), 22 hemangiomas (HMG), 6 hepatic adenomas (HA), and 11 other benign lesions (1 angiomyolipioma, 6 lesions histopathology diagnoses as benign without further specification, or ones lacking features of malignancy, and 4 lesions radiologically diagnosed as benign which remained stable in the follow-up studies). The group of malignant lesions consisted of primary 51 hepatocellular carcinomas, 12 metastases, and 11 metastases from melanoma malignum (MM meta). 7 FLLs were excluded (4 cases of uncertain histopathological diagnosis, 2 cholangiocarcinomas, and 1 regenerative nodule). For the included lesions ROI (region of interest) measurements were taken by two observers in the T2-w, ADC (apparent diffusion coefficient) and in the T1-w sequence in the hepatobiliary phase (HBP). The interobserver agreement was evaluated with the Wilcoxon test. The Kruskal - Wallis, Mann - Whitney U and post hoc Dunn\'s tests were applied to assess if there were any significant differences in the ROI values between individual lesions. The variables with the p values of < 0.05 were considered statistically significant.
RESULTS: We found significant differences in the ROI values between lesions with p < 0.0001. Strikingly high ROI values in the T2-w sequence were found for HMG. The lowest ADC values were encountered for metastases and MM metastases. The highest ROI values in the HBP were found for FNH, and the lowest for metastases. We also found statistically significant differences in the ROI values between benign and malignant lesions with benign lesions presenting statistically higher ROI values compared to malignant lesions.
CONCLUSIONS: There were significant differences in the ROI values among different types of FLLs. The predominant quantitative feature in the T2-w sequence was a strikingly high ROI value for HMG. Benign lesions presented statistically higher ROI values in the T2-w, ADC, and HBP sequences compared to malignant lesions. This was true for all lesions except for HA.
METHODS: 107 patients with 180 unequivocal FLLs in previous examinations were included in a single-center retrospective study. All patients underwent a MRI test of the liver with GA. 99 benign and 74 malignant lesions were included. The group of benign lesions consisted of 60 focal nodular hyperplasias (FNH), 22 hemangiomas (HMG), 6 hepatic adenomas (HA), and 11 other benign lesions (1 angiomyolipioma, 6 lesions histopathology diagnoses as benign without further specification, or ones lacking features of malignancy, and 4 lesions radiologically diagnosed as benign which remained stable in the follow-up studies). The group of malignant lesions consisted of primary 51 hepatocellular carcinomas, 12 metastases, and 11 metastases from melanoma malignum (MM meta). 7 FLLs were excluded (4 cases of uncertain histopathological diagnosis, 2 cholangiocarcinomas, and 1 regenerative nodule). For the included lesions ROI (region of interest) measurements were taken by two observers in the T2-w, ADC (apparent diffusion coefficient) and in the T1-w sequence in the hepatobiliary phase (HBP). The interobserver agreement was evaluated with the Wilcoxon test. The Kruskal - Wallis, Mann - Whitney U and post hoc Dunn\'s tests were applied to assess if there were any significant differences in the ROI values between individual lesions. The variables with the p values of < 0.05 were considered statistically significant.
RESULTS: We found significant differences in the ROI values between lesions with p < 0.0001. Strikingly high ROI values in the T2-w sequence were found for HMG. The lowest ADC values were encountered for metastases and MM metastases. The highest ROI values in the HBP were found for FNH, and the lowest for metastases. We also found statistically significant differences in the ROI values between benign and malignant lesions with benign lesions presenting statistically higher ROI values compared to malignant lesions.
CONCLUSIONS: There were significant differences in the ROI values among different types of FLLs. The predominant quantitative feature in the T2-w sequence was a strikingly high ROI value for HMG. Benign lesions presented statistically higher ROI values in the T2-w, ADC, and HBP sequences compared to malignant lesions. This was true for all lesions except for HA.
摘要：
目的：本研究旨在评估在gadoxeticacid（GA）增强肝脏MRI中区分局灶性肝脏病变（FLL）的定量特征，并确定这些特征是否可以准确区分良性和恶性病变。
方法：单中心回顾性研究纳入了107例先前检查中具有180个明确FLL的患者。所有患者均接受GA肝脏MRI检查。其中良性病变99例，恶性病变74例。良性病变组包括60例局灶性结节性增生（FNH），22血管瘤（HMG），6肝腺瘤（HA），和其他11个良性病变（1个血管平滑肌瘤，6个病变组织病理学诊断为良性，没有进一步说明，或者缺乏恶性肿瘤特征的，和4个放射学诊断为良性的病变，在后续研究中保持稳定）。该组恶性病变包括51例原发性肝细胞癌，12转移，和11个恶性黑色素瘤转移（MMmeta）。排除7例FLL（4例组织病理学诊断不确定，2胆管癌，和1个再生结节)。对于包括的病变，由两名观察者在T2-w中进行ROI（感兴趣区域）测量，ADC(表观扩散系数)和在T1-w序列中的肝胆相(HBP)。通过Wilcoxon检验评估了观察者之间的一致性。克鲁斯卡尔-沃利斯，采用Mann-WhitneyU和事后Dunn's检验来评估单个病变之间的ROI值是否存在显著差异。P值<0.05的变量被认为是统计学上显著的。
结果：我们发现p<0.0001的病变之间的ROI值存在显着差异。对于HMG,在T2-w序列中发现显著高的ROI值。对于转移和MM转移，ADC值最低。在HBP中发现FNH的最高ROI值，和最低的转移。我们还发现，良性和恶性病变之间的ROI值存在统计学上的显着差异，与恶性病变相比，良性病变的ROI值在统计学上较高。
结论：不同类型FLL的ROI值存在显著差异。T2-w序列中的主要定量特征是HMG的极高ROI值。良性病变在T2-W中呈现统计学上较高的ROI值，ADC,和HBP序列与恶性病变的比较。对于除HA以外的所有病变都是如此。
方法：单中心回顾性研究纳入了107例先前检查中具有180个明确FLL的患者。所有患者均接受GA肝脏MRI检查。其中良性病变99例，恶性病变74例。良性病变组包括60例局灶性结节性增生（FNH），22血管瘤（HMG），6肝腺瘤（HA），和其他11个良性病变（1个血管平滑肌瘤，6个病变组织病理学诊断为良性，没有进一步说明，或者缺乏恶性肿瘤特征的，和4个放射学诊断为良性的病变，在后续研究中保持稳定）。该组恶性病变包括51例原发性肝细胞癌，12转移，和11个恶性黑色素瘤转移（MMmeta）。排除7例FLL（4例组织病理学诊断不确定，2胆管癌，和1个再生结节)。对于包括的病变，由两名观察者在T2-w中进行ROI（感兴趣区域）测量，ADC(表观扩散系数)和在T1-w序列中的肝胆相(HBP)。通过Wilcoxon检验评估了观察者之间的一致性。克鲁斯卡尔-沃利斯，采用Mann-WhitneyU和事后Dunn's检验来评估单个病变之间的ROI值是否存在显著差异。P值<0.05的变量被认为是统计学上显著的。
结果：我们发现p<0.0001的病变之间的ROI值存在显着差异。对于HMG,在T2-w序列中发现显著高的ROI值。对于转移和MM转移，ADC值最低。在HBP中发现FNH的最高ROI值，和最低的转移。我们还发现，良性和恶性病变之间的ROI值存在统计学上的显着差异，与恶性病变相比，良性病变的ROI值在统计学上较高。
结论：不同类型FLL的ROI值存在显著差异。T2-w序列中的主要定量特征是HMG的极高ROI值。良性病变在T2-W中呈现统计学上较高的ROI值，ADC,和HBP序列与恶性病变的比较。对于除HA以外的所有病变都是如此。
