Usefulness of combining gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and contrast-enhanced ultrasound for diagnosing the macroscopic classification of small hepatocellular carcinoma
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Non-simple nodules in hepatocellular carcinoma (HCC) correlate with poor prognosis. Therefore, we examined the diagnostic ability of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) and contrast-enhanced ultrasound (CEUS) for diagnosing the macroscopic classification of small HCCs.
A total of 85 surgically resected nodules (≤30 mm) were analyzed.
HCCs were pathologically classified as simple nodular (SN) and non-SN. By evaluating hepatobiliary phase (HBP) of EOB-MRI and Kupffer phase of CEUS, the diagnostic abilities of both modalities to correctly distinguish between SN and non-SN were compared.
Forty-six nodules were diagnosed as SN and the remaining 39 nodules as non-SN. The area under the ROC curve (AUROCs, 95 % confidence interval) for the diagnosis of non-SN were EOB-MRI, 0.786 (0.682–0.890): CEUS, 0.784 (0.679–0.889), in combination, 0.876 (0.792–0.959). The sensitivity, specificity, and accuracy were 64.1 %, 95.7 %, and 81.2 % in EOB-MRI, 56.4 %, 97.8 %, and 78.8 % in CEUS, and 84.6 %, 95.7 %, and 90.6 % in combination, respectively. High diagnostic ability was obtained when diagnosed in both modalities combined. The sensitivity was especially statistically significant compared to CEUS.
Combined diagnosis by EOB-MRI and CEUS can provide high-quality imaging assessment for determining non-SN in small HCCs.
• Non-SN has a higher frequency of MVI and intrahepatic metastasis than SN.
• Macroscopic classification is useful to choose the treatment strategy for small HCCs.
• Diagnostic ability for macroscopic findings of EOB-MRI and CEUS were statistically equal.
• The diagnosis of macroscopic findings by individual modality has limitations.
• Combined diagnosis of EOB-MRI and CEUS provides high diagnostic ability.
KeywordsHepatocellular carcinoma Macroscopic findings Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging Contrast-enhanced ultrasound Combined diagnosis
Area under the receiver operating characteristic curve
Contrast-enhanced computed tomography
Confluent multinodular type
Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging
Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid
Hepatitis B virus
Hepatitis C virus
- ICG R15
Indocyanine green retention rate at 15 minutes
Patients negative for both HBs antigen and HCV antibody
Negative predictive value
Positive predictive value
Receiver operating characteristic
Simple nodular type with distinct margin
Simple nodular type with extranodular growth
Small nodular type with indistinct margin
The scientific guarantor of this publication is Kazuaki Chayama, M.D., Ph.D. 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: the MRI and CEUS contrast agents used in the present study were not provided/sponsored by the industry. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval and written informed consent were not required because this study is a retrospective analysis of EOB-MRI and CEUS, obtained for clinical purposes. Methodology: retrospective, diagnostic or prognostic study / observational, performed at one institution#.
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