Adding ancillary features to enhancement patterns of hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging improves diagnostic performance
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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.
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).
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.
KeywordsHepatocellular carcinoma Magnetic resonance imaging Diagnosis Enhancement Ancillary feature
Magnetic resonance imaging
European Association for the Study of the Liver
American Association for the Study of Liver Diseases
Extracellular contrast media
The liver imaging reporting and data system
Intrahepatic mass-forming cholangiocarcinoma
Positive predictive value
Negative predictive value
Compliance with ethical standards
Conflict of interest
No conflict of interest.
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