Differentiating malignant from benign hyperintense nodules on unenhanced T1-weighted images in patients with chronic liver disease: using gadoxetic acid-enhanced and diffusion-weighted MR imaging
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To evaluate value of gadoxetic acid-enhanced and diffusion-weighted (DW) MRI for distinguishing malignant from benign hyperintense nodules on unenhanced T1-weighted images (T1WIs) in patients with chronic liver disease.
Materials and methods
Forty-two patients with 37 malignant and 41 benign hyperintense nodules on unenhanced T1WIs who underwent gadoxetic acid-enhanced and DW MRI, followed by histopathological examination, were included. Qualitative and quantitative analyses were conducted. Significant findings on univariate and multivariate analyses were identified and their diagnostic performances were analyzed for predicting hyperintense hepatocellular carcinomas (HCCs).
In univariate analysis, hyperintensity on T2WI, arterial enhancement, washout, hypointensity on hepatobiliary phase, and diffusion restriction were more frequently observed (P < 0.05) in hyperintense HCCs. Tumor-to-liver SI ratio on hepatobiliary phase and minimum apparent diffusion coefficient (ADCmin) were significantly lower in hyperintense HCCs (P < 0.05). In multivariate analysis, hyperintensity on T2WI (OR, 13.58; P = 0.02), arterial enhancement (OR, 8.21; P = 0.002), and ADCmin ≤ 0.83 × 10−3 mm2/s (OR, 6.88; P = 0.008) were independently significant factors for predicting hyperintense HCCs. When two of three criteria were combined, 75.7% (28/37) of hyperintense HCCs were identified with a specificity of 92.7%, and when all three criteria were satisfied, the specificity was 97.6%.
Gadoxetic acid-enhanced and DW MRI may be helpful for differentiating malignant from benign hyperintense nodules on unenhanced T1WI.
KeywordsMagnetic resonance imaging Diffusion magnetic resonance imaging Hepatocellular carcinoma Apparent diffusion coefficient
Contrast enhancement index
Apparent diffusion coefficient
Region of interest
Receiver operating characteristic
Positive predictive value
Negative predictive value
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
All applicable institutional and/or national guidelines for the care and use of animals were followed.
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