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Differentiation of focal nodular hyperplasia and hepatocellular adenoma using qualitative and quantitative imaging features and classification and regression tree analysis

  • Hepatobiliary
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Abstract

Purpose

To assess qualitative and quantitative analysis of gadoxetate disodium-enhanced hepatobiliary phase MR imaging (MRI) and assess the performance of classification and regression tree analysis for the differentiation of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA).

Materials and methods

This retrospective study was approved by our local ethics committee. One hundred seventy patients suspected of having FNH or HCA underwent gadoxetate disodium-enhanced MRI. The reference standard was either pathology or follow-up imaging. Two readers reviewed images to identify qualitative imaging features and measure signal intensity on unenhanced, dynamic, and hepatobiliary phase images. For quantitative analysis, contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), signal intensity ratio (SIR), and relative signal enhancement ratio (RSER) were calculated. A classification and regression tree (CART) analysis was developed.

Results

Eighty-five patients met the inclusion criteria, with a total of 97 FNHs and 43 HCAs. For qualitative analysis, the T1 signal intensity on the hepatobiliary phase provided the highest overall classification performance (91.9% sensitivity, 90.1% specificity, and 90.9% accuracy). For quantitative analysis, RSER in the hepatobiliary phase with a threshold of 0.723 provided the highest classification performance (92.6% sensitivity and 89.4% specificity) to differentiate FNHs from HCAs. A CART model based on five qualitative imaging features provided an accuracy of 94.4% (95% confidence interval 90.0–98.9%).

Conclusion

Gadoxetate disodium-enhanced hepatobiliary phase provides high diagnostic performance as demonstrated in quantitative and qualitative analysis in differentiation of FNH and HCA, supported by a CART decision model.

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Abbreviations

CART:

Classification and regression tree

CE:

Contrast enhanced

CER:

Contrast enhancement ratio

FNH:

Focal nodular hyperplasia

HBP:

Hepatobiliary phase

HCA:

Hepatocellular adenoma

LLC:

Lesion-to-liver contrast

NPV:

Negative predictive value

PPV:

Positive predictive value

ROI:

Region of interest

RSER:

Relative signal enhancement ratio

SI:

Signal intensity

SIR:

Signal intensity ratio

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Acknowledgements

King Saud Medical City scholarship to Talal M Alamri. King Fahad Medical City scholarship to Mohammad Al Shaikh. Fonds de recherche du Québec en Santé (FRQ-S) and Fondation de l'association des radiologistes du Québec (FARQ) Clinical Research Scholarship—Senior Salary Award (FRQS-ARQ #298509o) to An Tang.

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Authors and Affiliations

  1. Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, H2X 0C1, Canada

    Talal M. Alamri, Milena Cerny, Mohammad Al Shaikh, Jean-Sébastien Billiard, Damien Olivié & An Tang

  2. Department of Radiology, King Saud Medical City, Riyadh, Saudi Arabia

    Talal M. Alamri

  3. Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada

    Milena Cerny & An Tang

  4. Department of Radiology, King Fahad Medical City, Riyadh, Saudi Arabia

    Mohammad Al Shaikh

  5. Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada

    Miguel Chagnon

Authors
  1. Talal M. Alamri
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  2. Milena Cerny
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  7. An Tang
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Correspondence to An Tang.

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Conflict of interest

Talal M. Al-Amri, Milena Cerny, Mohammad Al Shaikh, Jean-Sébastien Billiard, Damien Olivié, Miguel Chagnon, and An Tang declare that they have no financial conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived from all individual participants included in the study.

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Alamri, T.M., Cerny, M., Al Shaikh, M. et al. Differentiation of focal nodular hyperplasia and hepatocellular adenoma using qualitative and quantitative imaging features and classification and regression tree analysis. Abdom Radiol 48, 874–885 (2023). https://doi.org/10.1007/s00261-022-03766-0

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