Abdominal Radiology

, Volume 43, Issue 9, pp 2309–2320 | Cite as

Adding ancillary features to enhancement patterns of hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging improves diagnostic performance

  • Ji Hye Min
  • Young Kon KimEmail author
  • Dong Hyun Sinn
  • Seo-Youn Choi
  • Woo Kyoung Jeong
  • Won Jae Lee
  • Sang Yun Ha
  • Soohyun Ahn
  • Min-Ji Kim



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.


Hepatocellular carcinoma Magnetic resonance imaging Diagnosis Enhancement Ancillary feature 



Hepatocellular carcinoma


Magnetic resonance imaging


European Association for the Study of the Liver


American Association for the Study of Liver Diseases


Computed tomography


Hepatobiliary phase


Extracellular contrast media


The liver imaging reporting and data system


Intrahepatic mass-forming cholangiocarcinoma


Signal intensity


T1-weighted image


T2-weighted image


Positive predictive value


Negative predictive value


Compliance with ethical standards

Conflict of interest

No conflict of interest.

Supplementary material

261_2018_1480_MOESM1_ESM.pdf (414 kb)
Supplementary material 1 (PDF 414 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology, Chungnam National University HospitalChungnam National University College of MedicineDaejeonKorea
  3. 3.Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  4. 4.Department of Radiology, Soonchunhyang University College of MedicineBucheon HospitalBucheonRepublic of Korea
  5. 5.Department of Pathology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  6. 6.Biostatics and Clinical Epidemiology Center, Research Institute for Future MedicineSamsung Medical CenterSeoulRepublic of Korea

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