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Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤2 cm) HCC in cirrhosis

  • Magnetic Resonance
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Abstract

Objective

To prospectively assess the additional value of the hepatobiliary (HB) phase of Gd-EOB-DTPA-MRI in identifying and characterising small (≤2 cm) hepatocellular carcinomas (HCCs) undetermined in dynamic phases alone because of their atypical features, according to the AASLD criteria.

Methods

127 cirrhotic patients were evaluated with Gd-EOB-DTPA-MRI in two sets: unenhanced and dynamic phases; unenhanced, dynamic and HB phases. Sixty-two out of 215 nodules (29%) were atypical in 42 patients (33%).

Results

62 atypical nodules were reported at histology: high-grade dysplastic nodules (HGDN)/early HCC (n = 20), low-grade DN (LGDN) (n = 21), regenerative nodules (n = 17) and nodular regenerative hyperplasia (n = 4). The sensitivity, specificity, accuracy, positive and negative predictive value (PPV, NPV) were increased by the addition of the HB phase: 88.4–99.4%, 88–95%, 88–98.5%, 97–99%, and 65–97.5%, respectively. Twenty atypical nodules were malignant (32%), 19 of which were characterised only during the HB phase.

Conclusions

The HB phase is 11% more sensitive in the classification of HGDN/early HCC than dynamic MRI, with an added value of 32.5% in the NPV. The high incidence (33%) of atypical nodules and their frequent malignancy (32%) suggest the widespread employment of Gd-EOB-DTPA-MRI in the follow-up of small nodules (≤2 cm) in cirrhosis.

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Acknowledgment

Antonio Di Micoli M.D., Division of Internal Medicine, Department of Digestive Diseases and Internal Medicine; Sant’ Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy for the support in the statistical analysis

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Authors and Affiliations

  1. Radiology Unit, Department of Digestive Diseases and Internal Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Rita Golfieri, Matteo Renzulli, Vincenzo Lucidi & Beniamino Corcioni

  2. Unit of Semeiotica, Department of Digestive Diseases and Internal Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Franco Trevisani

  3. Unit of Internal Medicine, Department of Digestive Diseases and Internal Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Luigi Bolondi

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  1. Rita Golfieri
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Correspondence to Rita Golfieri.

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Golfieri, R., Renzulli, M., Lucidi, V. et al. Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤2 cm) HCC in cirrhosis. Eur Radiol 21, 1233–1242 (2011). https://doi.org/10.1007/s00330-010-2030-1

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