Retrospective validation of a new diagnostic criterion for hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout with the aid of ancillary features?
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To validate new diagnostic criteria for hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MR imaging (Gd-EOB-MRI) using hypointensity on the hepatobiliary phase (HBP) as an alternative to washout in combination with ancillary features.
This retrospective study included 288 patients at high risk for HCC with 387 nodules (HCCs, n=292; non-HCCs, n=95) showing arterial phase hyper-enhancement (APHE) ≥1 cm on Gd-EOB-MRI. Imaging diagnoses of HCCs were made using different criteria: APHE plus hypointensity on the portal venous phase (PVP) (criterion 1), APHE plus hypointensity on the PVP and/or transitional phase (TP) (criterion 2), APHE plus hypointensity on the PVP and/or TP and/or HBP (criterion 3), and criterion 3 plus non-LR-1/2/M according to the Liver Imaging Reporting and Data System (LI-RADS) v2017 considering ancillary features (criterion 4). Sensitivities and specificities of those criteria were compared using McNemar’s test.
Among diagnostic criteria for HCCs, criteria 3 and 4 showed significantly higher sensitivities (93.8% and 92.5%, respectively) than criteria 1 and 2 (70.9% and 86.6%, respectively) (p values <0.001). The specificity of criterion 4 (87.4%) was shown to be significantly higher than that of criterion 3 (48.4%, p<0.001), albeit comparable to criterion 2 (86.3%, p>0.999) and significantly lower than criterion 1 (97.9%, p=0.002).
In the non-invasive diagnosis of HCCs on Gd-EOB-MRI, HBP hypointensity may be used as an alternative to washout enabling a highly sensitive diagnosis with little loss in specificity if it is used after excluding nodules considered to be benignities or non-HCC malignancies based on characteristic imaging features.
• Gd-EOB-MRI enhancement and ancillary features can be used to diagnose HCC.
• Exclusion of LR-1/2/M improves specificity when HBP hypointensity is used.
KeywordsCarcinoma, hepatocellular Magnetic resonance imaging Liver Practice guideline
Hepatic arterial phase
Gadoxetic acid-enhanced magnetic resonance imaging
Liver Imaging Reporting and Data System
Portal venous phase
We thank Chris Woo, B.A. for editing the manuscript.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Jeong Min Lee.
Conflict of interest
The authors of this article declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
The same study cohort has been previously reported in Eur Radiol 2015; 25: 2859-68.
• Retrospective, diagnostic study, performed at one institution
- 4.European Association for the Study of the Liver (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. https://doi.org/10.1016/j.jhep.2018.03.019
- 13.Ye F, Liu J, Ouyang H (2015) Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging and multidetector-row computed tomography for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Medicine (Baltimore) 94:e1157CrossRefGoogle Scholar
- 17.Li X, Li C, Wang R, Ren J, Yang J, Zhang Y (2015) Combined application of gadoxetic acid disodium-enhanced Magnetic Resonance Imaging (MRI) and Diffusion-Weighted Imaging (DWI) in the diagnosis of chronic liver disease-induced hepatocellular carcinoma: a meta-analysis. PLoS One 10:e0144247CrossRefGoogle Scholar
- 20.Joo I, Lee JM, Lee DH, Jeon JH, Han JK, Choi BI (2015) Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout? Eur Radiol 25:2859–2868Google Scholar
- 21.Tang A, Bashir MR, Corwin MT et al (2017) Evidence supporting LI-RADS major features for CT- and MR imaging-based diagnosis of hepatocellular carcinoma: a systematic review. Radiology. https://doi.org/10.1148/radiol.2017170554:170554
- 22.Kim SS, Hwang JC, Lim SG, Ahn SJ, Cheong JY, Cho SW (2014) Effect of virological response to entecavir on the development of hepatocellular carcinoma in hepatitis B viral cirrhotic patients: comparison between compensated and decompensated cirrhosis. Am J Gastroenterol 109:1223–1233CrossRefGoogle Scholar
- 25.Kielar AZ, Chernyak V, Bashir MR et al (2018) LI-RADS 2017: an update. J Magn Reson Imaging. https://doi.org/10.1002/jmri.26027
- 28.Allen BC, Ho LM, Jaffe TA, Miller CM, Mazurowski MA, Bashir MR (2018) Comparison of visualization rates of LI-RADS version 2014 major features with IV gadobenate dimeglumine or gadoxetate disodium in patients at risk for hepatocellular carcinoma. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.17.18981:1-7
- 29.Kim YY, An C, Kim S, Kim MJ (2017) Diagnostic accuracy of prospective application of the Liver Imaging Reporting and Data System (LI-RADS) in gadoxetate-enhanced MRI. Eur Radiol. https://doi.org/10.1007/s00330-017-5188-y
- 31.Ronot M, Fouque O, Esvan M, Lebigot J, Aube C, Vilgrain V (2017) Comparison of the accuracy of AASLD and LI-RADS criteria for the non-invasive diagnosis of HCC smaller than 3 cm. J Hepatol. https://doi.org/10.1016/j.jhep.2017.12.014
- 36.Fraum TJ, Tsai R, Rohe E et al (2017) Differentiation of hepatocellular carcinoma from other hepatic malignancies in patients at risk: diagnostic performance of the liver imaging reporting and data system version 2014. Radiology. https://doi.org/10.1148/radiol.2017170114:170114
- 37.Cerny M, Bergeron C, Billiard JS et al (2018) LI-RADS for MR imaging diagnosis of hepatocellular carcinoma: performance of major and ancillary features. Radiology. https://doi.org/10.1148/radiol.2018171678:171678