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Gadoxetate disodium-enhanced MRI for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: late portal venous phase may improve identification of enhancing capsule

  • Hepatobiliary
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate added value of late portal venous phase (LPVP) for identification of enhancing capsule (EC) on gadoxetate disodium-enhanced MRI (GD-MRI) for diagnosing hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD).

Methods

This retrospective study comprised 116 high-risk patients with 128 pathologically proven HCCs who underwent GD-MRI including arterial phase, conventional portal venous phase (CPVP, 60 s), LPVP (mean, 104.4 ± 6.7 s; range, 90–119 s), and transitional phase (TP, 3 min). Two independent radiologists assessed the presence of major HCC features, including EC on CPVP and/or TP (CPVP/TP) and EC on LPVP. The frequency of EC was compared on GD-MRI between with and without inclusion of LPVP. The radiologists assigned Liver Imaging Reporting and Data System (LI-RADS) v2018 categories before and after identifying EC on LPVP.

Results

Of the total 128 HCCs, 74 and 73 revealed EC on CPVP/TP for reviewer 1 and 2, respectively. After inclusion of LPVP, each reviewer identified seven more EC [Reviewer 1, 57.8% (74/128) vs. 63.3% (81/128); Reviewer 2, 57.0% (73/128) vs. 62.5% (80/128); P = 0.016, respectively]. Sensitivities of LR-5 assignment for diagnosing HCCs were not significantly different in GD-MRI with or without LPVP for EC identification [Reviewer 1, 71.9% (92/128) vs. 72.7% (93/128); Reviewer 2, 75.0% (96/128) vs. 75.8% (97/128); P = 1.000, respectively].

Conclusion

Including the LPVP in GD-MRI may improve identification of EC of HCC in patients with CLD. However, LI-RADS v2018 using GD-MRI showed comparable sensitivity for diagnosing HCC regardless of applying LPVP for EC.

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Abbreviations

3D:

Three-dimensional

APHE:

Arterial phase hyperenhancement

CLD:

Chronic liver disease

CPVP:

Conventional portal venous phase

CPVP/LPVP/TP:

Conventional portal venous phase and/or late portal venous phase and/or transitional phase

CPVP/TP:

Conventional portal venous phase and/or transitional phase

DP:

Delayed phase

EASL:

European Association for the Study of the Liver

EC:

Enhancing capsule

ECCA:

Extracellular contrast agent

GD-MRI:

Gadoxetate disodium-enhanced magnetic resonance imaging

GRE:

Gradient-echo

HBA:

Hepatobiliary agent

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

LPVP:

Late portal venous phase

MRI:

Magnetic resonance imaging

PVP:

Portal venous phase

T1WI:

T1-weighted image

TIV:

Tumor in vein

TP:

Transitional phase

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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) (Grant No. 2018R1C1B5085419).

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Authors and Affiliations

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

    Hyeji Kim, Seung Soo Kim, Hyeong Cheol Shin, Woong Hee Lee, Chan Ho Park, Hyoung Nam Lee, Shin Young Kim & Hyerim Park

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

    Seo-Youn Choi & Ji Eun Lee

  3. Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Cheonan-si, Chungcheongnam-do, Korea

    Nam Hun Heo

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  1. Hyeji Kim
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Contributions

All authors contributed to the patient care and had access to the data and a role in writing this manuscript. SSK: Conceptualization. SSK, S-YC, JEL: Data curation. NHH: Formal analysis. SSK, HCS, S-YC: Investigation. SSK: Methodology. HK, SSK: Writing—Original draft. SSK, WHL, CHP, HNL, SYK, HP: 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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Kim, H., Kim, S.S., Shin, H.C. et al. Gadoxetate disodium-enhanced MRI for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: late portal venous phase may improve identification of enhancing capsule. Abdom Radiol 48, 621–629 (2023). https://doi.org/10.1007/s00261-022-03756-2

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