Japanese Journal of Radiology

, Volume 36, Issue 8, pp 489–499 | Cite as

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

  • Ji Yoon Moon
  • Seong Hyun KimEmail author
  • Seo-Youn Choi
  • Jeong Ah Hwang
  • Ji Eun Lee
  • Jisun Lee
Original Article



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.


Magnetic resonance imaging Diffusion magnetic resonance imaging Hepatocellular carcinoma Apparent diffusion coefficient 



Diffusion weighted


T1-weighted image


T2-weighted image


Signal intensity


Contrast enhancement index


Apparent diffusion coefficient


Odds ratio


Magnetic resonance


Hepatocellular carcinoma




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.

Ethical approval

All applicable institutional and/or national guidelines for the care and use of animals were followed.


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Copyright information

© Japan Radiological Society 2018

Authors and Affiliations

  • Ji Yoon Moon
    • 1
  • Seong Hyun Kim
    • 2
    Email author
  • Seo-Youn Choi
    • 3
  • Jeong Ah Hwang
    • 4
  • Ji Eun Lee
    • 3
  • Jisun Lee
    • 5
  1. 1.Department of Radiology, Kangdong Seong-Sim HospitalHallym University College of MedicineSeoulSouth Korea
  2. 2.Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  3. 3.Department of RadiologySoonchunhyang University Bucheon HospitalBucheonSouth Korea
  4. 4.Department of RadiologySoonchunhyang University Cheonan HospitalCheonanSouth Korea
  5. 5.Department of RadiologyChungbuk National University HospitalCheongju-siSouth Korea

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