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- Title
Pediatric Hepatoblastoma After Neoadjuvant Chemotherapy: Diagnostic Performance of MR in Staging POSTTEXT and Vascular Involvement.
- Authors
Gong, Xu Hua; Feng, Ming Xuan; Zhuang, Zhi Guo; Yan, Yun Qi; Wang, Li; Ren, Hai Nan; Zhu, Yi; Song, Yang; Qian, Li Jun; Xu, Jian Rong; Zhou, Yan; Xia, Qiang
- Abstract
Background: The assessment of resectability after neoadjuvant chemotherapy of hepatoblastoma is dependent on Post‐Treatment EXTENT of Disease (POSTTEXT) staging and its annotation factors P (portal venous involvement) and V (hepatic venous/inferior vena cava [IVC] involvement), but MR performance in assessing them remains unclear. Purpose: To assess the diagnostic performance of contrast‐enhanced MR imaging for preoperative POSTTEXT staging and diagnosing vascular involvement in terms of annotation factors P and V in pediatric hepatoblastoma following neoadjuvant chemotherapy. Study Type: Retrospective. Subjects: Thirty‐five consecutive patients (17 males, median age, 24 months; age range, 6–98 months) with proven hepatoblastoma underwent preoperative MR imaging following neoadjuvant chemotherapy. Field Strength/Sequence: 3.0 T; T2‐weighted imaging (T2WI), T2WI with fat suppression, diffusion weighted imaging, radial stack‐of‐the‐star/Cartesian 3D Dixon T1‐weighted gradient echo imaging. Assessment: Three radiologists independently assessed the POSTTEXT stages and annotation factors P and V based on the 2017 PRE/POSTTEXT system. The sensitivities and specificities were calculated for 1) diagnosing each POSTTEXT stage; 2) discrimination of stages III and IV (advanced) from those stages I and II (non‐advanced) hepatoblastomas; and 3) annotation factors P and V. The combination of pathologic findings and surgical records served as the reference standard. Statistical Tests: Sensitivity, specificity, Fleiss kappa test. Results: The sensitivity and specificity ranges for discriminating advanced from non‐advanced hepatoblastomas were 73.3%–80.0% and 80.0%–90.0%, respectively. For annotation factor P, they were 66.7%–100.0% and 90.6%, respectively. For factor V, they were 75.0% and 67.7%–83.9%, respectively. There was excellent, substantial, and moderate agreement on POSTTEXT staging (Fleiss kappa = 0.82), factors P (Fleiss kappa = 0.64), and factors V (Fleiss kappa = 0.60), respectively. Data Conclusion: MR POSTTEXT provides reliable discrimination between advanced and non‐advanced tumors, and MR has moderate to excellent specificity at identifying portal venous and hepatic venous/IVC involvement. Evidence Level: 3 Technical Efficacy: Stage 3
- Subjects
NEOADJUVANT chemotherapy; ECHO-planar imaging; HEPATOBLASTOMA; VENA cava inferior; MAGNETIC resonance imaging; PORTAL hypertension
- Publication
Journal of Magnetic Resonance Imaging, 2024, Vol 59, Issue 3, p1034
- ISSN
1053-1807
- Publication type
Article
- DOI
10.1002/jmri.28848