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Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout?

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine which dynamic phase(s) of gadoxetic acid-enhanced MRI is most appropriate to assess “washout” in the noninvasive diagnosis of hepatocellular carcinoma (HCC) based on hemodynamic pattern.

Methods

In this retrospective cohort study, 288 consecutive patients with chronic liver disease presented with 387 arterially enhancing nodules (292 HCCs, 95 non-HCCs) (≥1 cm) on gadoxetic acid-enhanced MRI. All HCCs were confirmed by histopathology or by their typical enhancement pattern on dynamic liver CT. MR imaging diagnosis of HCC was made using criteria of arterial enhancement and hypointensity relative to the surrounding parenchyma (1) on the portal-venous phase (PVP), (2) on the PVP and/or transitional phase (TP), or (3) on the PVP and/or TP, and/or hepatobiliary phase (HBP).

Results

For the noninvasive diagnosis of HCC, criterion 1 provided significantly higher specificity (97.9 %; 95 % confidence interval, 92.6 – 99.7 %) than criteria 2 (86.3 %; 77.7 – 92.5 %), or 3 (48.4 %; 38.0 – 58.9 %). Conversely, higher sensitivity was obtained with criterion 3 (93.8 %; 90.4 – 96.3 %) than with criterion 2 (86.6 %; 82.2 – 90.3 %) or 1 (70.9 %; 65.3 – 76.0 %).

Conclusions

To make a sufficiently specific diagnosis of HCC using gadoxetic acid-enhanced MRI based on typical enhancement features, washout should be determined on the PVP alone rather than combined with hypointensity on the TP or HBP.

Key points

• Gadoxetic acid-enhanced MRI enhancement features can be used to diagnose HCC.

• Washout should be determined on the PVP alone for high specificity.

• Hypointensity on the TP or HBP increases sensitivity but lowers specificity.

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Abbreviations

HCC:

hepatocellular carcinoma

HAP:

hepatic arterial phase

PVP:

portal-venous phase

TP:

transitional phase

HBP:

hepatobiliary phase

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Acknowledgments

The scientific guarantor of this publication is Jeong Min Lee. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. No complex statistical methods were necessary for this paper.

This study was approved by the institutional review board of Seoul National University Hospital. Written informed consent was waived by the institutional review board. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution. We thank Chris Woo, B.A. for his editing.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Ijin Joo, Jeong Min Lee, Dong Ho Lee, Ju Hyeon Jeon, Joon Koo Han & Byung Ihn Choi

  2. Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea

    Ijin Joo, Jeong Min Lee, Dong Ho Lee, Ju Hyeon Jeon, Joon Koo Han & Byung Ihn Choi

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea

    Jeong Min Lee, Joon Koo Han & Byung Ihn Choi

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Correspondence to Jeong Min Lee.

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Joo, I., Lee, J.M., Lee, D.H. et al. Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout?. Eur Radiol 25, 2859–2868 (2015). https://doi.org/10.1007/s00330-015-3686-3

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  • DOI: https://doi.org/10.1007/s00330-015-3686-3

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