Evaluation of Early-stage Hepatocellular Carcinoma by Magnetic Resonance Imaging with Gadoxetic Acid Detects Additional Lesions and Increases Overall Survival
Menée à partir de données portant sur 700 patients atteints d'un carcinome hépatocellulaire de stade précoce traité entre 2009 et 2010, cette étude coréenne évalue l'intérêt d'ajouter à une tomographie numérique une IRM rehaussée par l'acide gadoxétique pour détecter d'autres lésions hépatiques et améliorer la survie sans récidive ou la survie globale des patients
Background and 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%; median size of the primary HCCs, 2.8 cm vs 2.6 cm). Seventy-four additional HCC nodules were detected in 53 (16.4%) of the patients who underwent MR evaluation following CT (CT+MR group). These detections increased Barcelona Clinic Liver Cancer stages for 43 patients (13.3%) and modified their treatment plans. Upon 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 propensity score, the CT+MR group had significantly lower overall mortality (HR, 0.66; 95% CI, 0.44−0.99).
Conclusion : Among patients who underwent dynamic CT analysis of a single-nodular HCC, additional evaluation by MR imaging with gadoxetic acid led to detection of additional HCC nodules in 16% of patients, reduced risk of disease recurrence, and lowered overall mortality.
Gastroenterology , résumé, 2014