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Subcentimeter hepatocellular carcinoma in treatment-naïve patients: noninvasive diagnostic criteria and tumor staging on gadoxetic acid–enhanced MRI

  • Magnetic Resonance
  • Published:
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Abstract

Objective

It is controversial to adopt non-invasive diagnostic criteria of hepatocellular carcinoma (HCC) in subcentimeter lesions. This study was aimed to define the optimal noninvasive diagnostic criteria of subcentimeter HCC and to evaluate the effect on tumor staging.

Methods

We included 110 treatment-naïve patients at risk of HCC and eligible for curative treatment who had subcentimeter lesions (n = 136) on gadoxetic acid–enhanced magnetic resonance imaging (MRI) performed between January 2013 and December 2013. Modified diagnostic criteria for subcentimeter HCC were developed using logistic regression analysis. Accuracies of MR staging with and without using the modified criteria were compared by generalized estimating equation test using pathologic staging as reference standards. Subgroup analysis was performed for patients with co-existing HCC ≥ 1 cm (co-HCC).

Results

The modified criteria (presence of co-HCC, arterial phase hyperenhancement, and hypointensity on transitional phase [TP]) showed 61.5% (95% CI, 41.6–78.2) of sensitivity and 98.2% (95% CI, 93.0–99.5) of specificity. Including subcentimeter HCCs improved the accuracy of MR staging from 84.5 to 94.5% (p = 0.001). Fifty percent of subcentimeter lesions found in patients with co-HCCs were HCC, whereas 5.9% of them without co-HCCs were HCC (p = 0.001). In the subgroup with co-HCCs, the accuracy of MR staging with subcentimeter HCCs was improved from 69.0% to 92.8% (p = 0.001).

Conclusions

Including subcentimeter HCCs based on the modified diagnostic criteria (co-existing HCC ≥ 1 cm, arterial phase hyperenhancement, and hypointensity on TP) improved MR staging accuracy.

Key Points

• Fifty percent of non-benign appearing subcentimeter lesions found in patients with co-HCCs were HCC, whereas 5.9% of them without co-HCCs were HCC (p = 0.001).

• Including subcentimeter HCCs improved the accuracy of MR staging from 84.5 to 94.5% (p = 0.001).

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Abbreviations

BCLC:

Barcelona Clinic Liver Cancer

co-HCC:

Co-existing HCC ≥ 1 cm

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

PVP:

Portal venous phase

TP:

Transitional phase

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Acknowledgments

We would like to thank Editage (www.editage.co.kr) and Helen H. Soh (BS, Boston University School of Medicine, Boston, Massachusetts) for the English language editing.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Shin Hye Hwang and Seung Baek Hong contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Shin Hye Hwang & Mi-Suk Park

  2. Department of Radiology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Republic of Korea

    Shin Hye Hwang & Sumi Park

  3. Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea

    Seung Baek Hong & So Yeon Kim

  4. Department of Radiology, Busan University Hospital, Busan University College of Medicine, Busan, Republic of Korea

    Seung Baek Hong

  5. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Kyunghwa Han

  6. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Young Nyun Park

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  1. Shin Hye Hwang
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Correspondence to Mi-Suk Park.

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Guarantor

The scientific guarantor of this publication is Mi-suk Park.

Conflict of interest

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.

Statistics and biometry

One of the authors has significant statistical expertise.

Kyunghwa Han (Department of Radiology, Severance Hospital, Seoul, South Korea)

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Total of 27.3% (30 of 110) of the study subjects are overlapped with the cohort of a published study reporting that the hypointensity in transitional phase and non-enhancing capsule appearance are valuable for HCC (Abdom Radiol 2019;44:3078–3088). However, the objectives of the present study, image analysis, and statistical assessment are independent from the previous study.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

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Co-first authorship Shin Hye Hwang and Seung Baek Hong

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Hwang, S.H., Hong, S.B., Park, S. et al. Subcentimeter hepatocellular carcinoma in treatment-naïve patients: noninvasive diagnostic criteria and tumor staging on gadoxetic acid–enhanced MRI. Eur Radiol 31, 2321–2331 (2021). https://doi.org/10.1007/s00330-020-07329-z

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