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Impact of hepatobiliary phase liver MRI versus Contrast-Enhanced Ultrasound after an inconclusive extracellular gadolinium-based contrast-enhanced MRI for the diagnosis of benign hepatocellular tumors

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Abstract

Purpose

To compare the added values of hepatobiliary phase (HBP) MRI and contrast-enhanced ultrasound (CEUS) in addition to inconclusive extracellular gadolinium-based contrast-enhanced MRI (CE-MRI) to characterize benign hepatocellular tumors (BHT).

Methods

Eighty-three BHT-46 focal nodular hyperplasia (FNH) and 37 hepatocellular adenomas (HCA)-with inconclusive CE-MRI in 54 patients (43 women and 11 men, mean age 42 years old ± 14.8) were retrospectively analyzed. All patients underwent both HBP-MRI and CEUS. Two radiologists independently reviewed 2 sets of images, SET-1: CE-MRI and HBP-MRI; SET-2: CE-MRI and CEUS, and classified lesions as “definite FNH,” “possible FNH,” or “definitely not FNH.” Sensitivity (Se) and specificity (Spe) were compared between the two sets; subgroup analyses according to the lesion’s size were performed.

Results

Regardless of lesion size, the respective Se and Spe of both datasets were not statistically different (95.7 and 100% vs. 76.1 and 94.6% for set-1 and -2 respectively; p = 0.18). For lesions larger than 35 mm, although both sets had similar specificity (100%), sensitivity was higher for SET-1 (100% vs. 40%); p = 0.04. Tumor classifications using SET-1 and SET-2 could have changed patient management in 35/54 (64.8%) and 33/54 (61.1%) of all patients, respectively.

Conclusions

HBP-MRI or CEUS should be performed after an inconclusive CE-MRI. Both can change patient management by avoiding unnecessary biopsy or surveillance. The use of HBP-MRI should be advocated over CEUS in larger (>35 mm) lesions.

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Authors and Affiliations

  1. Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France

    Lambros Tselikas, Frederic Pigneur, Marion Roux, Laurence Baranes, Vincent Roche, Edouard Herin, Alain Rahmouni & Alain Luciani

  2. Hepatology Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France

    Charlotte Costentin & Ariane Mallat

  3. Department of Pathology, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France

    Julien Calderaro & Elie Zafrani

  4. Universite Paris Est Creteil, Créteil, 94010, France

    Julien Calderaro, Alexis Laurent, Daniel Azoulay, Ariane Mallat, Alain Rahmouni & Alain Luciani

  5. Liver Surgery Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France

    Alexis Laurent & Daniel Azoulay

  6. INSERM IMRB Unit U 955, Equipe 18, Créteil, 94010, France

    Alexis Laurent & Alain Luciani

Authors
  1. Lambros Tselikas
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  2. Frederic Pigneur
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  3. Marion Roux
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  4. Laurence Baranes
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  6. Vincent Roche
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  7. Julien Calderaro
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  13. Alain Rahmouni
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Corresponding author

Correspondence to Alain Luciani.

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Research involving Human Participants (adults) was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards (IRB approved).

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Tselikas, L., Pigneur, F., Roux, M. et al. Impact of hepatobiliary phase liver MRI versus Contrast-Enhanced Ultrasound after an inconclusive extracellular gadolinium-based contrast-enhanced MRI for the diagnosis of benign hepatocellular tumors. Abdom Radiol 42, 825–832 (2017). https://doi.org/10.1007/s00261-016-0921-6

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