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Combined computed tomography and magnetic resonance imaging improves diagnosis of hepatocellular carcinoma ≤ 3.0 cm

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Abstract

Background/purpose

Imaging diagnosis of hepatocellular carcinoma (HCC) is important, but the diagnostic performance of combined computed tomography (CT) and magnetic resonance imaging (MRI) using the Liver Imaging Reporting and Data System (LI-RADS) v2018 is not fully understood. We evaluated the clinical usefulness of combined CT and MRI for diagnosing HCC ≤ 3.0 cm using LI-RADS.

Methods

In 222 patients at risk of HCC who underwent both contrast-enhanced dynamic CT and gadoxetate disodium-enhanced MRI in 2017, 291 hepatic nodules ≤ 3.0 cm were retrospectively analyzed. Two radiologists performed image analysis and assigned a LI-RADS category to each nodule. The diagnostic performance for HCC was evaluated for CT, ordinary-MRI (washout confined to portal venous-phase), and modified-MRI (washout extended to hepatobiliary phase), and sensitivity and specificity were calculated for each modality. Generalized estimating equations were used to compare the diagnostic performance for HCC between combined CT and ordinary-MRI, combined CT and modified-MRI, and CT or MRI alone. p < 0.0062 (0.05/8) was considered statistically significant following Bonferroni correction for multiple comparisons.

Results

In 291 nodules, the sensitivity and specificity of CT, ordinary-MRI, and modified-MRI were 70.2% and 92.8%, 72.6% and 96.4%, and 84.6% and 88.0%, respectively. Compared with CT or MRI alone, both combined CT and ordinary-MRI (sensitivity, 83.7%; specificity, 95.2%) and combined CT and modified-MRI (sensitivity, 88.9%; specificity, 89.2%) showed significantly higher sensitivity (p ≤ 0.006), without a significant decrease in specificity (p ≥ 0.314).

Conclusions

Compared with CT or MRI alone, combined CT and MRI can increase sensitivity for diagnosing HCC ≤ 3.0 cm, without a significant decrease in specificity.

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Availability of data and material

Data are available upon reasonable request.

Abbreviations

AASLD:

American Association for the Study of Liver Disease

APHE:

Arterial-phase hyperenhancement

EC:

Enhancing capsule

ECA:

Extracellular contrast agent

HBA:

Hepatobiliary contrast agent

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

RFA:

Radiofrequency ablation

TACE:

Transcatheter arterial chemoembolization

WO:

Washout

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Funding

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Grant number: NRF-2019R1G1A1099743).

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Author notes

  1. Chul-min Lee and Sang Hyun Choi shared co-first authorship.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Chul-min Lee, Sang Hyun Choi, Jae Ho Byun, So Jung Lee, So Yeon Kim, Hyung Jin Won, Yong Moon Shin & Pyo-Nyun Kim

  2. Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea

    Chul-min Lee

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  1. Chul-min Lee
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Corresponding author

Correspondence to Jae Ho Byun.

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Conflict of interest

Sang Hyun Choi is an advisory board member of Bayer Schering Healthcare and receives research funding from Bayer Schering Healthcare. Others have nothing to declare.

Ethics approval

Institutional Review Board of Asan Medical Center approved this study.

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The requirement for informed patient consent was waived because of the retrospective study design.

Code availability

SPSS version 25.0 (IBM, Armonk, NY) and SAS v 9.4 (SAS Institute, Cary, NC).

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Lee, Cm., Choi, S.H., Byun, J.H. et al. Combined computed tomography and magnetic resonance imaging improves diagnosis of hepatocellular carcinoma ≤ 3.0 cm. Hepatol Int 15, 676–684 (2021). https://doi.org/10.1007/s12072-021-10190-x

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  • DOI: https://doi.org/10.1007/s12072-021-10190-x

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