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Adding ancillary features to enhancement patterns of hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging improves diagnostic performance

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Abstract

Purpose

To assess the added value of intratumoral ancillary features to conventional enhancement pattern-based diagnosis of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI).

Materials and methods

A total of 773 consecutive patients with surgically resected 773 primary hepatic tumors (699 HCCs, 63 intrahepatic cholangiocarcinomas, and 11 benign nodules) who underwent gadoxetic acid-enhanced MRI were retrospectively identified. Enhancement patterns and three ancillary features of capsule, septum, and T2 spotty hyperintensity were assessed by two radiologists. Performance of enhancement pattern-based diagnosis of HCC was compared to diagnosis of HCC based on enhancement pattern plus ancillary features.

Results

Enhancement patterns were positive (arterial diffuse hyperenhancement with washout) for 562 (72.7%) tumors, negative (no arterial hyperenhancement and no washout) for 75 (9.7%), and inconclusive (either no arterial hyperenhancement or no washout) for 136 (17.6%). Capsule was observed in 498 (64.4%) tumors, septum in 521 (67.3%), and T2 spotty hyperintensity in 107 (13.8%). The accuracy and sensitivity of HCC diagnosis was improved significantly after adding at least one ancillary feature compared with enhancement pattern-based diagnosis of HCCs (79.9% vs. 91.1% for accuracy, p < 0.0001 and 79.1% vs. 92.0% for sensitivity, p < 0.0001) with a minor tradeoff in specificity (87.8% vs. 82.4%, p = 0.125). Adding at least two ancillary features improved accuracy (88.1%, p < 0.0001) and sensitivity (88.1%, p < 0.0001) without changing specificity (87.8%, p = 1.0).

Conclusion

Adding intratumoral ancillary features of capsule, septum and T2 spotty hyperintensity to conventional enhancement patterns on gadoxetic acid-enhanced MRI improved accuracy and sensitivity, while maintaining specificity for HCC diagnosis.

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Abbreviations

HCC:

Hepatocellular carcinoma

MRI:

Magnetic resonance imaging

EASL:

European Association for the Study of the Liver

AASLD:

American Association for the Study of Liver Diseases

CT:

Computed tomography

HBP:

Hepatobiliary phase

ECCM:

Extracellular contrast media

LI-RADS:

The liver imaging reporting and data system

IMCC:

Intrahepatic mass-forming cholangiocarcinoma

SI:

Signal intensity

T1WI:

T1-weighted image

T2WI:

T2-weighted image

PPV:

Positive predictive value

NPV:

Negative predictive value

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Author notes

  1. Ji Hye Min

    Present address: Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Republic of Korea

    Ji Hye Min, Young Kon Kim, Woo Kyoung Jeong & Won Jae Lee

  2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Dong Hyun Sinn

  3. Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea

    Seo-Youn Choi

  4. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Sang Yun Ha

  5. Biostatics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea

    Soohyun Ahn & Min-Ji Kim

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Correspondence to Young Kon Kim.

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Min, J.H., Kim, Y.K., Sinn, D.H. et al. Adding ancillary features to enhancement patterns of hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging improves diagnostic performance. Abdom Radiol 43, 2309–2320 (2018). https://doi.org/10.1007/s00261-018-1480-9

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