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Added value of hepatobiliary phase gadoxetic acid-enhanced MRI for diagnosing hepatocellular carcinoma in high-risk patients

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World Journal of Gastroenterology 2013年第45期19卷 8357-8365页

作者： Sith Phongkitkarun Kuruwin Limsamutpetch Penampai Tannaphai janjira jatchavala Department of Diagnostic and Therapeutic Radiology Faculty of Medicine Ramathibodi Hospital Mahidol University Ratchatewi Bangkok 10400 Thailand

AIM:To determine the added value of hepatobiliary phase(HBP)gadoxetic acid-enhanced magnetic resonance imaging(MRI)in evaluating hepatic nodules in high-risk ***:The institutional review board approved this retrospective study and waived the requirement for informed *** study included 100 patients at high risk for hepatocellular carcinoma(HCC)and 105hepatic nodules that were larger than 1 cm.A blind review of two MR image sets was performed in a random order:set 1,unenhanced(T1-and T2-weighted)and dynamic images;and set 2,unenhanced,dynamic20-min and HBP *** diagnostic accuracy,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were compared for the two image *** and multivariate analyses were performed on the MR characteristics utilized to diagnose ***:A total of 105 hepatic nodules were identified in 100 ***-nine nodules were confirmed to be *** diameter of the 59 HCCs ranged from1 to 12 cm(mean:1.9 cm).The remaining 46 nodules were benign(28 were of hepatocyte origin,nine were hepatic cysts,seven were hemangiomas,one was chronic inflammation,and one was focal fat infiltration).The diagnostic accuracy significantly increased with the addition of HBP images,from 88.7%in set 1to 95.5%in set 2(P=0.002).In set 1 vs set 2,the sensitivity and NPV increased from 79.7%to 93.2%and from 78.9%to 91.8%,respectively,whereas the specificity and PPV were not significantly *** hypointensity on the HBP images was the most sensitive(93.2%),and typical arterial enhancement followed by washout was the most specific(97.8%).The multivariate analysis revealed that typical arterial enhancement followed by washout,hyperintensity on T2-weighted images,and hypointensity on HBP images were statistically significant MRI findings that could diagnose HCC(P<0.05).CONCLUSION:The addition of HBP gadoxetic acidenhanced MRI statistically improved the diagnostic accuracy in HCCs larger than

关键词： Magnetic resonance imaging Liver Gadoxetic acid Hepatobiliary phase Hepatocellular carcinoma

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Assessment of gastrointestinal stromal tumors with computed tomography following treatment with imatinib mesylate

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World Journal of Gastroenterology 2008年第6期14卷 892-898页

作者： Sith Phongkitkarun Cholada Phaisanphrukkun janjira jatchavala Ekaphop Sirachainan Department of Radiology Faculty of Medicine Ramathibodi Hospital Mahidol University Rama Ⅵ Rd. Ratchathewi Bangkok 10400 Thailand Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Rama Ⅵ Rd. Ratchathewi Bangkok 10400 Thailand

AIM: To evaluate and characterize the patterns of disease progression of metastatic or unresectable gastrointestinal stromal tumor (GIST) treated with imatinib mesylate, and to determine the prognostic significance associated with disease progression. METHODS: Clinical data and computed tomography (CT) images were retrospectively reviewed in 17 GIST patients who were treated with imatinib mesylate from October 2002 to October 2006. Apart from using size measurement for evaluation of tumor response [Response Evaluation Criteria in Solid Tumors (RECIST) criteria], patterns of CT changes during treatment were evaluated and correlated with clinical data. RESULTS: There were eight non-responders and nine responders. Five patterns of CT change during treatment were found: focal progression (FP), generalized progression (GP), generalized cystic change (GC), new cystic lesion (NC) and new solid lesion (NS). At the end of study, all non-responders showed GP, whereas responders showed cystic change (GC and NC) and response according to RECIST criteria. Overall survival was significantly better in patients with cystic change or response within the RECIST criteria compared with GP patients (P = 0.0271). CONCLUSION: Various patterns of CT change in patients with GIST who responded to imatinib mesylate were demonstrated, and might determine the prognosis of the disease. A combination of RECIST criteria and pattern of CT change are proposed for response evaluation in GIST.

关键词： Computed tomography Gastrointestinal stromal tumor Imatinib mesylate

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