SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2017/09  
 
  2017 Sep;67(3):526-534.  
  doi: 10.1016/j.jhep.2017.04.024  
 
  Preoperative gadoxetic acid–enhanced MRI for predicting microvascular invasion in patients with single hepatocellular carcinoma  
 
  Lee S, Kim SH, Lee JE, Sinn DH, Park CK  
  https://www.ncbi.nlm.nih.gov/pubmed/28483680  
 
 

Abstract

BACKGROUND & AIMS:

This study aimed to identify preoperative magnetic resonance (MR) imaging biomarkers for predicting microvascular invasion (MVI), to determine their diagnostic performance and to evaluate whether they are associated with early recurrence after surgery for single hepatocellular carcinoma (HCC).

METHODS:

The study included 197 patients with surgically resected HCC (≤5cm) who underwent preoperative gadoxetic acid-enhanced MR imaging. Significant MR imaging findings for predicting MVI were identified by univariate and multivariate analyses. Early recurrence rates (<2years) were analyzed with respect to significant imaging findings for predicting MVI.

RESULTS:

Three MR imaging features were independently associated with MVI: arterial peritumoral enhancement (odds ratio [OR]=5.184; 95% confidence interval [CI]: 2.228, 12.063; p<0.001), non-smooth tumor margin (OR=3.555; 95% CI: 1.627, 7.769; p=0.001), and peritumoral hypointensity on hepatobiliary phase (HBP) (OR=4.705; 95% CI: 1.671, 13.246; p=0.003). When two of three findings were combined, the specificity was 92.5% (124/134). When all three findings were satisfied, the specificity was 99.3% (133/134). Early recurrence rates were significantly higher in patients with single HCC, with two or three significant MR imaging findings, compared to those with none (27.9% vs. 12.6%, respectively, p=0.030).

CONCLUSIONS:

A combination of two or more of the following; arterial peritumoral enhancement, non-smooth tumor margin, and peritumoral hypointensity on HBP, can be used as a preoperative imaging biomarker for predicting MVI, with specificity >90%, and is associated with early recurrence after surgery of single HCC. Lay summary: A combination of two or more of the following; arterial peritumoral enhancement, non-smooth tumor margin, and peritumoral hypointensity on hepatobiliary phase, can be used as a preoperative imaging biomarker for predicting microvascular invasion, with specificity >90%, and is associated with early recurrence after curative resection of single HCC.

 

  
Question posée
 
Cette étude visait à identifier les critères d'imagerie par résonance magnétique préopératoire (MR) pour prédire l'invasion microvasculaire (MVI), afin de déterminer leur performance diagnostique et évaluer si ils sont associées à une récidive précoce après une intervention chirurgicale pour un carcinome hépatocellulaire unique (CHC).
  
Question posée
 
L’amélioration péri-tumorale artérielle, la marge tumorale « non lisse » et l'hypo-densité péri-tumorale sur la phase hépato-biliaire, peuvent être utilisées comme critères d'imagerie préopératoire pour prédire l'invasion microvasculaire, avec une spécificité> 90%, ils sont associés à une récidive prématurée après résection curative d'un CHC unique.
  
Commentaires

Probablement de nouveaux critères pertinents pour évaluer l’intérêt d’une chirurgie dans cette indication.
 
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