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Gadoxetic acid-enhanced MRI for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: can hypointensity on the late portal venous phase be used as an alternative to washout?

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the added value of considering hypointensity on late portal venous phase (LPVP) images as washout for diagnosis of hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced MRI (Gd-EOB-MRI) in patients with chronic liver disease (CLD).

Methods

This retrospective study comprised 97 patients at high risk for HCC who underwent Gd-EOB-MRI including unenhanced, multi-arterial phase, conventional portal venous phase (CPVP, 60 s), and LPVP (mean, 99.9 ± 9.1 s; range, 90–119 s) images. A total of 115 hepatic lesions were identified by histopathological or clinical diagnosis. Three independent radiologists assessed the MRI images by consensus. Diagnosis of HCC was made using criteria of arterial hyperenhancement and hypointensity relative to the surrounding liver parenchyma (1) on CPVP or (2) on CPVP and/or LPVP images. The generalized estimating equation was used to compare diagnostic performance for HCC between Criterion 1 and 2.

Results

In 82 HCCs, the frequency of hypointensity differed significantly between the CPVP and LPVP images (64.6% [53/82] vs. 84.1% [69/82], P < 0.001). Among 33 non-HCCs, two cHCC-CCs showed additional hypointensity on LPVP than CPVP images (33.3% [11/33] vs. 39.4% [13/33], P = 0.500). Criterion 2 provided significantly greater sensitivity for diagnosing HCC than Criterion 1 (54.9% [45/82] vs. 74.4% [61/82], P < 0.001), with relatively little reduction in specificity (90.9% [30/33] vs. 84.8% [28/33], P = 0.145).

Conclusion

Additional use of LPVP hypointensity as washout could significantly improve sensitivity for HCC diagnosis when utilizing Gd-EOB-MRI in patients with CLD, without a significant decrease in specificity.

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Abbreviations

3D:

Three-dimensional

AASLD:

American Association for the Study of Liver Disease

cHCC-CC:

Combined hepatocellular-cholangiocarcinoma

CLD:

Chronic liver disease

CPVP:

Conventional portal venous phase

CT:

Computed tomography

DN:

Dysplastic nodule

DP:

Delayed phase

EASL:

European Association for the Study of the Liver

ECCA:

Extracellular-contrast-agent

Gd-EOB-MRI:

Gadoxetic acid-enhanced magnetic resonance imaging

GRE:

Gradient echo

HBCA:

Hepatobiliary-contrast-agent

HCC:

Hepatocellular carcinoma

HHN:

Hypervascular hyperplastic nodule

IHCC:

Intrahepatic cholangiocarcinoma

LPVP:

Late portal venous phase

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

PVP:

Portal venous phase

RN:

Regenerative nodule

TP:

Transitional phase

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Funding

Funding

This work was supported by the Soonchunhyang University Research Fund and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2018R1C1B5085419).

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Authors and Affiliations

  1. Department of Radiology, Cheonan Hospital, Soonchunhyang University College of Medicine, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-Si, 330-721, Chungcheongnam-do, Republic of Korea

    Kyoung A. Baek, Seung Soo Kim, Hyeong Cheol Shin, Jeong Ah Hwang, Woong Hee Lee, Chan Ho Park & Hyoung Nam Lee

  2. Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea

    Seo-Youn Choi

  3. Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Cheonan-Si, Chungcheongnam-do, Republic of Korea

    Nam Hun Heo

  4. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jeong Ah Hwang

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  1. Kyoung A. Baek
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Contributions

Author contributions

All authors contributed to the patient care and had access to the data and a role in writing this manuscript. SSK: Conceptualization, SSK: Data curation, NHH: Formal analysis, SSK, HCS, JAH, S-YC: Investigation, SSK: Methodology, KAB, SSK: Writing—original draft, KAB, SSK, WHL, CHP, HNL: Writing—review & editing

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Correspondence to Seung Soo Kim.

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All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Institutional Review Board approval was obtained.

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Baek, K.A., Kim, S.S., Shin, H.C. et al. Gadoxetic acid-enhanced MRI for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: can hypointensity on the late portal venous phase be used as an alternative to washout?. Abdom Radiol 45, 2705–2716 (2020). https://doi.org/10.1007/s00261-020-02553-z

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