대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제82권2호
  • /
  • Pages.280-297
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  • 2021
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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간세포암 감시를 위한 단축 자기공명영상의 최신지견

Recent Updates of Abbreviated MRI for Hepatocellular Carcinoma Screening

  • 김정우 (고려대학교 의과대학 고려대학교 구로병원 영상의학과) ;
  • 이창희 (고려대학교 의과대학 고려대학교 구로병원 영상의학과)
  • Jeong Woo Kim (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Chang Hee Lee (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine)
  • 투고 : 2021.02.08
  • 심사 : 2021.03.17
  • 발행 : 2021.03.01
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초록

간세포암 위험이 있는 환자들에 대해 국제 가이드라인들은 6개월마다 초음파로 감시할 것을 권고하고 있다. 그러나 초음파는 초기 간세포암을 발견하는 데에 낮은 민감도를 보인다. 한편, 자기공명영상(MRI)은 간세포암을 비침습적으로 진단하는 데 중요한 역할을 하지만, 검사 시간이 길고 비용이 높아서 감시 검사로는 적합하지 않다. 따라서 비조영증강 단축 MRI, 역동적 조영증강 단축 MRI, 그리고 간담도기영상을 포함한 단축 MRI 등 다양한 단축 MRI 전략들을 간세포암 감시에 이용한 여러 연구들이 있었다. 이 종설에서는 다양한 단축 MRI 전략들을 살펴보고, 비용-효과적인 측면을 고려하여 간세포암 감시의 앞으로 나아가야 할 방향에 대해 살펴보고자 한다.

International guidelines recommended screening with ultrasonography (US) every 6 months for patients at risk for hepatocellular carcinoma (HCC). However, US demonstrates low sensitivity for the early detection of HCC. Magnetic resonance imaging (MRI) plays an important role in the noninvasive diagnosis of HCC, but it is not suitable for surveillance due to its lengthy examination and high cost. Therefore, several studies have been using various abbreviated MRI strategies, including noncontrast abbreviated MRI, dynamic contrast-enhanced abbreviated MRI, and abbreviated MRI using hepatobiliary phase image for HCC surveillance. In this article, we aim to review these various strategies and explore the future direction of HCC surveillance considering the cost-effectiveness aspect.

키워드

참고문헌

  1. Villanueva A. Hepatocellular carcinoma. N Engl J Med 2019;380:1450-1462 
  2. Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 2017;3:524-548 
  3. The Korean Liver Cancer Association. 2018 Korean Liver Cancer Association-National Cancer Center (KLCANCC) Hepatocellular Carcinoma Practice Guideline. Available at. https://livercancer.or.kr/study/guidelines.php. Assessed Feb 8, 2021 
  4. Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 2018;67:358-380 
  5. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130:417-422 
  6. Tzartzeva K, Obi J, Rich NE, Parikh ND, Marrero JA, Yopp A, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis. Gastroenterology 2018;154:1706-1718.e1 
  7. Singal A, Volk ML, Waljee A, Salgia R, Higgins P, Rogers MA, et al. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther 2009;30:37-47 
  8. Singal AG, Conjeevaram HS, Volk ML, Fu S, Fontana RJ, Askari F, et al. Effectiveness of hepatocellular carcinoma surveillance in patients with cirrhosis. Cancer Epidemiol Biomarkers Prev 2012;21:793-799 
  9. Del Poggio P, Olmi S, Ciccarese F, Di Marco M, Rapaccini GL, Benvegnu L, et al. Factors that affect efficacy of ultrasound surveillance for early stage hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol 2014;12:1927-1933.e2 
  10. Simmons O, Fetzer DT, Yokoo T, Marrero JA, Yopp A, Kono Y, et al. Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis. Aliment Pharmacol Ther 2017;45:169-177 
  11. Chou R, Cuevas C, Fu R, Devine B, Wasson N, Ginsburg A, et al. Imaging techniques for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Ann Intern Med 2015;162:697-711 
  12. Lee YJ, Lee JM, Lee JS, Lee HY, Park BH, Kim YH, et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis. Radiology 2015;275:97-109 
  13. Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 2013;266:376-382 
  14. American College of Radiology. CT/MRI Liver Imaging Reporting and Data System version 2018 core. Available at. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS/CT-MRI-LI-RADSv2018. Assessed Feb 8, 2021 
  15. American College of Radiology. Liver Imaging Reporting and Data System version 2014. Available at. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS. Assessed Feb 8, 2021 
  16. Khatri G, Pedrosa I, Ananthakrishnan L, de Leon AD, Fetzer DT, Leyendecker J, et al. Abbreviated-protocol screening MRI vs. complete-protocol diagnostic MRI for detection of hepatocellular carcinoma in patients with cirrhosis: an equivalence study using LI-RADS v2018. J Magn Reson Imaging 2020;51:415-425 
  17. Canellas R, Rosenkrantz AB, Taouli B, Sala E, Saini S, Pedrosa I, et al. Abbreviated MRI Protocols for the Abdomen. Radiographics 2019;39:744-758 
  18. Kielar AZ, Chernyak V, Bashir MR, Do RK, Fowler KJ, Santillan C, et al. An update for LI-RADS: version 2018. Why so soon after version 2017? J Magn Reson Imaging 2019;50:1990-1991 
  19. Elsayes KM, Kielar AZ, Chernyak V, Morshid A, Furlan A, Masch WR, et al. LI-RADS: a conceptual and historical review from its beginning to its recent integration into AASLD clinical practice guidance. J Hepatocell Carcinoma 2019;6:49-69 
  20. Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol 2014;32:2304-2310 
  21. Besa C, Lewis S, Pandharipande PV, Chhatwal J, Kamath A, Cooper N, et al. Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid. Abdom Radiol (NY) 2017;42:179-190 
  22. Park YN, Kim YB, Yang KM, Park C. Increased expression of vascular endothelial growth factor and angiogenesis in the early stage of multistep hepatocarcinogenesis. Arch Pathol Lab Med 2000;124:1061-1065 
  23. Sutherland T, Watts J, Ryan M, Galvin A, Temple F, Vuong J, et al. Diffusion-weighted MRI for hepatocellular carcinoma screening in chronic liver disease: direct comparison with ultrasound screening. J Med Imaging Radiat Oncol 2017;61:34-39 
  24. Tang L, Zhou XJ. Diffusion MRI of cancer: from low to high b-values. J Magn Reson Imaging 2019;49:23-40 
  25. Kim YK, Kim YK, Park HJ, Park MJ, Lee WJ, Choi D. Noncontrast MRI with diffusion-weighted imaging as the sole imaging modality for detecting liver malignancy in patients with high risk for hepatocellular carcinoma. Magn Reson Imaging 2014;32:610-618 
  26. Han S, Choi JI, Park MY, Choi MH, Rha SE, Lee YJ. The diagnostic performance of liver MRI without intravenous contrast for detecting hepatocellular carcinoma: a case-controlled feasibility study. Korean J Radiol 2018;19:568-577 
  27. Chan MV, McDonald SJ, Ong YY, Mastrocostas K, Ho E, Huo YR, et al. HCC screening: assessment of an abbreviated non-contrast MRI protocol. Eur Radiol Exp 2019;3:49 
  28. Whang S, Choi MH, Choi JI, Youn SY, Kim DH, Rha SE. Comparison of diagnostic performance of non-contrast MRI and abbreviated MRI using gadoxetic acid in initially diagnosed hepatocellular carcinoma patients: a simulation study of surveillance for hepatocellular carcinomas. Eur Radiol 2020;30:4150-4163 
  29. Park HJ, Jang HY, Kim SY, Lee SJ, Won HJ, Byun JH, et al. Non-enhanced magnetic resonance imaging as a surveillance tool for hepatocellular carcinoma: comparison with ultrasound. J Hepatol 2020;72:718-724 
  30. Vietti Violi N, Lewis S, Liao J, Hulkower M, Hernandez-Meza G, Smith K, et al. Gadoxetate-enhanced abbreviated MRI is highly accurate for hepatocellular carcinoma screening. Eur Radiol 2020;30:6003-6013 
  31. Lee JY, Huo EJ, Weinstein S, Santos C, Monto A, Corvera CU, et al. Evaluation of an abbreviated screening MRI protocol for patients at risk for hepatocellular carcinoma. Abdom Radiol (NY) 2018;43:1627-1633 
  32. Ishigami K, Yoshimitsu K, Nishihara Y, Irie H, Asayama Y, Tajima T, et al. Hepatocellular carcinoma with a pseudocapsule on gadolinium-enhanced MR images: correlation with histopathologic findings. Radiology 2009;250:435-443 
  33. Marks RM, Ryan A, Heba ER, Tang A, Wolfson TJ, Gamst AC, et al. Diagnostic per-patient accuracy of an abbreviated hepatobiliary phase gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance. AJR Am J Roentgenol 2015;204:527-535 
  34. Tillman BG, Gorman JD, Hru JM, Lee MH, King MC, Sirlin CB, et al. Diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI protocol for hepatocellular carcinoma screening. Clin Radiol 2018;73:485-493 
  35. Brunsing RL, Chen DH, Schlein A, Wolfson T, Gamst A, Mamidipalli A, et al. Gadoxetate-enhanced abbreviated MRI for hepatocellular carcinoma surveillance: preliminary experience. Radiology: Imaging Cancer 2019;1:e190010 
  36. Kitao A, Matsui O, Yoneda N, Kozaka K, Kobayashi S, Koda W, et al. Hypervascular hepatocellular carcinoma: correlation between biologic features and signal intensity on gadoxetic acid-enhanced MR images. Radiology 2012;265:780-789 
  37. Narita M, Hatano E, Arizono S, Miyagawa-Hayashino A, Isoda H, Kitamura K, et al. Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma. J Gastroenterol 2009;44:793-798 
  38. Lee SA, Lee CH, Jung WY, Lee J, Choi JW, Kim KA, et al. Paradoxical high signal intensity of hepatocellular carcinoma in the hepatobiliary phase of Gd-EOB-DTPA enhanced MRI: initial experience. Magn Reson Imaging 2011;29:83-90 
  39. Lee S, Kim SH, Park CK, Kim YS, Lee WJ, Lim HK. Comparison between areas with Gd-EOB-DTPA uptake and without in hepatocellular carcinomas on Gd-EOB-DTPA-enhanced hepatobiliary-phase MR imaging: pathological correlation. J Magn Reson Imaging 2010;32:719-725 
  40. An JY, Pena MA, Cunha GM, Booker MT, Taouli B, Yokoo T, et al. Abbreviated MRI for hepatocellular carcinoma screening and surveillance. Radiographics 2020;40:1916-1931 
  41. An C, Kim DY, Choi JY, Han KH, Roh YH, Kim MJ. Noncontrast magnetic resonance imaging versus ultrasonography for hepatocellular carcinoma surveillance (MIRACLE-HCC): study protocol for a prospective randomized trial. BMC Cancer 2018;18:915 
  42. Kim HA, Kim KA, Choi JI, Lee JM, Lee CH, Kang TW, et al. Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol. BMC Cancer 2017;17:877 
  43. Lima PH, Fan B, Berube J, Cerny M, Olivie D, Giard JM, et al. Cost-utility analysis of imaging for surveillance and diagnosis of hepatocellular carcinoma. AJR Am J Roentgenol 2019;213:17-25 
  44. Goossens N, Singal AG, King LY, Andersson KL, Fuchs BC, Besa C, et al. Cost-effectiveness of risk score-stratified hepatocellular carcinoma screening in patients with cirrhosis. Clin Transl Gastroenterol 2017;8:e101 
  45. Park YS, Lee J, Kim JW, Park CM, Lee CH. Second shot arterial phase to overcome degraded hepatic arterial phase in liver MR imaging. Eur Radiol 2019;29:2821-2829 
  46. Kim JW, Lee CH, Park YS, Lee J, Kim KA. Abbreviated gadoxetic acid-enhanced mri with second-shot arterial phase imaging for liver metastasis evaluation. Radiology: Imaging Cancer 2019;1:e190006