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Improved differentiation of Primaray liver cancer by combination of Amide Transfer weighted imaging(APTw) and T2 mapping1The First Affiliated Hospital of Dalian Medical University, Dalian, China, 2Philips Healthcare, Beijing, China
Synopsis
Hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) are the most common types of primary liver cancer, which differ greatly in terms of pathogenesis, biological behavior, histological morphology, treatment and prognosis. The accurate diagnosis of HCC and ICC is important for treatment options. In this retrospective study, we revealed that APTw combined with T2 mapping could improve the differential diagnosis of HCC and ICC. Results showed that APTw combined with T2 mapping had higher efficacy (AUC:0.910). Further analysis also implied moderate correlations between APTw and T2 mapping.
Introduction
Primary liver cancer mainly consists of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), which differ greatly in terms of pathogenesis, biological behavior, histological morphology, treatment and prognosis[1,2] The accurate diagnosis of HCC and ICC is important for treatment options. However, due to overlaps in typical imaging findings, the differential diagnosis of HCC and ICC is still challenging[3]. APTw is a novel imaging tool which is based on endogenous amide protons in mobile cellular proteins and peptides in tissue [4], it has showed great potential for the diagnosis of central nervous system diseases and cervical cancer[5,6]. T2 mapping is a quantitative MRI technique which was used to measure altered water binding related to physiological or pathological macromolecular environmental changes[7]. The purpose of this study was to explore the value of APTw imaging combined with T2 mapping in the differential diagnosis of HCC and ICC.Materials and Methods
This research has been approved by the local IRB. 25 patients (with clinical symptoms and MRI image characteristics of primary liver cancer) were recruited in this study, which consisted of 16 HCC patients (14 men, 2women; mean age, 61 years; range, 43–76 years) and 9 ICC patients (7 men, 2 women; mean age, 62 years; range, 47–71 years). All patients were scanned using a 3.0 T MR scanner (Ingenia CX, Philips Healthcare, the Netherlands). The detail scan parameters were shown in Table 1. An experienced radiologist manually placed the ROIs (100 - 200 mm2) on the axial slice of APTw images (Figure 1), and T1/T2 mapping images with the largest lesions according to the high resolution T2W images. APTw values (in percent, representing the magnetization transfer ratio asymmetry in the z-spectrum) and T1/T2 values were compared between the HCC and ICC groups using Mann-Whitney U test, respectively. ROC curves were used to analyze the diagnostic efficiency of APTw, T1/T2 and combination of APTw with T2 mapping in HCC and ICC. The diagnostic value of the combination of APTw and T1/T2 value was calculated by logistic regression. The difference between AUCs was compared using Delong test. Spearman’s bivariate correlation was employed to assess the correlation of APTw values with T1/T2 value. A p -value < 0.05 was considered statistically significant.Result
The values of APTw, T1 and T2 from HCC and ICC patients were shown in Table 2 (Figure 2). APTw, and T2 showed significant difference between HCC and ICC groups, whereas T1 has no signicant difference. The ROC analyses revealed the diagnostic performance of APTw, and T2 in differentiating HCC from ICC, with AUCs of 0.750 and 0.868, respectively (Table 3). The AUC of APTw combined with T2 mapping was 0.910. When APTw and T2 mapping were combined, the sensitivity was 87.50%, and the specificity was 88.89% (cut-off value:0.576) (Figure 2, Table 4).Discussion and conclusion
ICC is histologically characterized by adenoid secretion or mucous secretion, and thus leading to the elevation of the level of mobile proteins and peptides. This might be the reason why APTw values are higher for ICC than HCC. T2 value derived from T2 mapping imaging measured altered water binding related to physiological or pathological macromolecular environmental changes, so ICC with more mucous secretion had higher T2 value than HCC. When the APTw values were combined with T2, the AUC was improved to 0.910.. In conclusion, the combination of APTw and T2 mapping could enhance the differentiation efficacy of HCC and ICC in primary liver cancer.Acknowledgements
No.References
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