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European Radiology

, Volume 25, Issue 11, pp 3272–3281 | Cite as

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

  • Tomoki Kobayashi
  • Hiroshi AikataEmail author
  • Masahiro Hatooka
  • Kei Morio
  • Reona Morio
  • Hiromi Kan
  • Hatsue Fujino
  • Takayuki Fukuhara
  • Keiichi Masaki
  • Atsushi Ohno
  • Noriaki Naeshiro
  • Takashi Nakahara
  • Yohji Honda
  • Eisuke Murakami
  • Tomokazu Kawaoka
  • Masataka Tsuge
  • Akira Hiramatsu
  • Michio Imamura
  • Yoshiiku Kawakami
  • Hideyuki Hyogo
  • Shoichi Takahashi
  • Kazuaki Chayama
Hepatobiliary-Pancreas

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

Combined diagnosis by EOB-MRI and CEUS can provide high-quality imaging assessment for determining non-SN in small HCCs.

Key Points

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.

Keywords

Hepatocellular carcinoma Macroscopic findings Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging Contrast-enhanced ultrasound Combined diagnosis 

Abbreviations

AFP

Alpha-fetoprotein

AP

Arterial-phase

AUROC

Area under the receiver operating characteristic curve

CECT

Contrast-enhanced computed tomography

CEUS

Contrast-enhanced ultrasound

CMN

Confluent multinodular type

DCP

Des-γ-carboxyprothrombin

EOB-MRI

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging

Gd-EOB-DTPA

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid

HBP

Hepatobiliary phase

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

ICG R15

Indocyanine green retention rate at 15 minutes

IF

Infiltrative type

MVI

Microvascular invasion

NBNC

Patients negative for both HBs antigen and HCV antibody

NPV

Negative predictive value

PPV

Positive predictive value

PVP

Portal venous-phase

ROC

Receiver operating characteristic

SN

Simple nodular

SN-DM

Simple nodular type with distinct margin

SN-EG

Simple nodular type with extranodular growth

SN-IN

Small nodular type with indistinct margin

US

Ultrasound

Notes

Acknowledgments

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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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Tomoki Kobayashi
    • 1
  • Hiroshi Aikata
    • 1
    Email author
  • Masahiro Hatooka
    • 1
  • Kei Morio
    • 1
  • Reona Morio
    • 1
  • Hiromi Kan
    • 1
  • Hatsue Fujino
    • 1
  • Takayuki Fukuhara
    • 1
  • Keiichi Masaki
    • 1
  • Atsushi Ohno
    • 1
  • Noriaki Naeshiro
    • 1
  • Takashi Nakahara
    • 1
  • Yohji Honda
    • 1
  • Eisuke Murakami
    • 1
  • Tomokazu Kawaoka
    • 1
  • Masataka Tsuge
    • 1
  • Akira Hiramatsu
    • 1
  • Michio Imamura
    • 1
  • Yoshiiku Kawakami
    • 1
  • Hideyuki Hyogo
    • 1
  • Shoichi Takahashi
    • 1
  • Kazuaki Chayama
    • 1
    • 2
  1. 1.Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
  2. 2.Liver Research Project CenterHiroshima UniversityHiroshimaJapan

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