Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

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).

Results

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%.

Conclusion

Gadoxetic acid-enhanced and DW MRI may be helpful for differentiating malignant from benign hyperintense nodules on unenhanced T1WI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig.1
Fig.2
Fig.3
Fig.4

Similar content being viewed by others

Abbreviations

DW:

Diffusion weighted

T1WI:

T1-weighted image

T2WI:

T2-weighted image

SI:

Signal intensity

CEI:

Contrast enhancement index

ADC:

Apparent diffusion coefficient

OR:

Odds ratio

MR:

Magnetic resonance

HCC:

Hepatocellular carcinoma

AFP:

Alpha-fetoprotein

ROI:

Region of interest

ROC:

Receiver operating characteristic

PPV:

Positive predictive value

NPV:

Negative predictive value

References

  1. Matsui O, Kadoya M, Kameyama T, Yoshikawa J, Arai K, Gabata T, et al. Adenomatous hyperplastic nodules in the cirrhotic liver: differentiation from hepatocellular carcinoma with MR imaging. Radiology. 1989;173:123–6.

    Article  PubMed  CAS  Google Scholar 

  2. Choi BI, Takayasu K, Han MC. Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis, and imaging findings. Am J Roentgenol. 1993;160:1177–87.

    Article  CAS  Google Scholar 

  3. Dodd GD, Baron RL, Oliver JH, Federle MP. Spectrum of imaging findings of the liver in end-stage cirrhosis: part II, focal abnormalities. Am J Roentgenol. 1999;173:1185–92.

    Article  Google Scholar 

  4. Ebara M, Fukuda H, Kojima Y, Morimoto N, Yoshikawa M, Sugiura N, et al. Small hepatocellular carcinoma: relationship of signal intensity to histopathologic findings and metal content of the tumor and surrounding hepatic parenchyma. Radiology. 1999;210:81–8.

    Article  PubMed  CAS  Google Scholar 

  5. Shimizu A, Ito K, Sasaki K, Hayashida M, Tanabe M, Shimizu K, et al. Small hyperintense hepatic lesions on T1-weighted images in patients with cirrhosis: evaluation with serial MRI and imaging features for clinical benignity. Magn Reson Imaging. 2007;25:1430–6.

    Article  PubMed  Google Scholar 

  6. Yu JS, Lee JH, Park MS, Kim KW. Hyperintense nodules on non-enhanced T1-weighted gradient-echo magnetic resonance imaging of cirrhotic liver: fate and clinical implications. J Magn Reson Imaging. 2006;24:630–6.

    Article  PubMed  Google Scholar 

  7. Yu JS, Kim YH, Rofsky NM. Dynamic subtraction magnetic resonance imaging of cirrhotic liver: assessment of high signal intensity lesions on nonenhanced T1-weighted images. J Comput Assist Tomogr. 2005;29:51–8.

    Article  PubMed  Google Scholar 

  8. Nasu K, Kuroki Y, Tsukamoto T, Nakajima H, Mori K, Minami M. Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. AJR Am J Roentgenol. 2009;193:438–44.

    Article  PubMed  Google Scholar 

  9. Parikh T, Drew SJ, Lee VS, Wong S, Hecht EM, Babb JS, et al. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology. 2008;246:812–22.

    Article  PubMed  Google Scholar 

  10. Nakanishi M, Chuma M, Hige S, Omatsu T, Yokoo H, Nakanishi K, et al. Relationship between diffusion-weighted magnetic resonance imaging and histological tumor grading of hepatocellular carcinoma. Ann Surg Oncol. 2012;19:1302–9.

    Article  PubMed  Google Scholar 

  11. International Working Party. Terminology of nodular hepatocellular lesions. Hepatology. 1995;22:983–93

    Article  Google Scholar 

  12. Kojiro M, Wanless IR, Alves V, et al. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology. 2009;49:658–64

    Article  Google Scholar 

  13. Song KD, Kim SH, Lee J, Kang KA, Kim J, Yoo H. Half-dose gadoxetic acid-enhanced liver magnetic resonance imaging in patients at risk for nephrogenic systemic fibrosis. Eur J Radiol. 2015;84:378–83.

    Article  PubMed  Google Scholar 

  14. Ebara M, Watanabe S, Kita K, Yoshikawa M, Sugiura N, Ohto M, et al. MR imaging of small hepatocellular carcinoma: effect of intratumoral copper content on signal intensity. Radiology. 1991;180:617–21.

    Article  PubMed  CAS  Google Scholar 

  15. Shinmura R, Matsui O, Kobayashi S, Terayama N, Sanada J, Ueda K, et al. Cirrhotic nodules: association between MR imaging signal intensity and intranodular blood supply. Radiology. 2005;237:512–9.

    Article  PubMed  Google Scholar 

  16. Chou CT, Chen YL, Wu HK, Chen RC. Characterization of hyperintense nodules on precontrast T1-weighted MRI: utility of gadoxetic acid-enhanced hepatocyte-phase imaging. J Magn Reson Imaging. 2011;33:625–32.

    Article  PubMed  Google Scholar 

  17. Li CS, Chen RC, Lii JM, Chen WT, Shih LS, Zhang TA, et al. Magnetic resonance imaging appearance of well-differentiated hepatocellular carcinoma. J Comput Assist Tomogr. 2006;30:597–603.

    Article  PubMed  Google Scholar 

  18. Curvo-Semedo L, Brito JB, Seco MF, Costa JF, Marques CB, Caseiro-Alves F. The hypointense liver lesion on T2-weighted MR images and what it means. Radiographics. 2010;30:e38.

    Article  PubMed  Google Scholar 

  19. Krinsky GA, Theise ND, Rofsky NM, Mizrachi H, Tepperman LW, Weinreb JC. Dysplastic nodules in cirrhotic liver: arterial phase enhancement at CT and MR imaging—a case report. Radiology. 1998;209:461–4.

    Article  PubMed  CAS  Google Scholar 

  20. Lim JH, Cho JM, Kim EY, Park CK. Dysplastic nodules in liver cirrhosis: evaluation of hemodynamics with CT during arterial portography and CT hepatic arteriography. Radiology. 2000;214:869–74.

    Article  PubMed  CAS  Google Scholar 

  21. Yu JS, Rofsky NM. Dynamic subtraction MR imaging of the liver: advantages and pitfalls. Am J Roentgenol. 2003;180:1351–7.

    Article  Google Scholar 

  22. Mannelli L, Kim S, Hajdu CH, Babb JS, Clark TWI, Taouli B. Assessment of tumor necrosis of hepatocellular carcinoma after chemoembolization: diffusion-weighted and contrast-enhanced MRI with histopathologic correlation of the explanted liver. Am J Roentgenol. 2009;193:1044–52.

    Article  Google Scholar 

  23. Nishie A, Tajima T, Asayama Y, Ishigami K, Kakihara D, Nakayama T, et al. Diagnostic performance of apparent diffusion coefficient for predicting histological grade of hepatocellular carcinoma. Eur J Radiol. 2011;80:e29–33.

    Article  PubMed  Google Scholar 

  24. Bruegel M, Holzapfel K, Gaa J, Woertler K, Waldt S, Kiefer B, et al. Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol. 2008;18:477–85.

    Article  PubMed  Google Scholar 

  25. Padhani AR, Liu G, Mu-Koh D, Chenevert TL, Thoeny HC, Takahara T, et al. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia (New York). 2009;11:102–25.

    Article  CAS  Google Scholar 

  26. Hardie AD, Kizziah MK, Boulter DJ. Diagnostic accuracy of diffusion-weighted MRI for identifying hepatocellular carcinoma with liver explant correlation. J Med Imaging Radiat Oncol. 2011;55:362–7.

    Article  PubMed  Google Scholar 

  27. Lee MH, Kim SH, Park MJ, Park CK, Rhim H. Gadoxetic acid-enhanced hepatobiliary phase MRI and high-b-value diffusion-weighted imaging to distinguish well-differentiated hepatocellular carcinomas from benign nodules in patients with chronic liver disease. AJR Am J Roentgenol. 2011;197:W868–75.

    Article  PubMed  Google Scholar 

  28. Muhi A, Ichikawa T, Motosugi U, Sano K, Matsuda M, Kitamura T, et al. High-b-value diffusion-weighted MR imaging of hepatocellular lesions: estimation of grade of malignancy of hepatocellular carcinoma. J Magn Reson Imaging. 2009;30:1005–11.

    Article  PubMed  Google Scholar 

  29. Ahn SS, Kim MJ, Lim JS, Hong HS, Chung YE, Choi JY. Added value of gadoxetic acid-enhanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma. Radiology. 2010;255:459–66.

    Article  PubMed  Google Scholar 

  30. Yu MH, Kim JH, Yoon JH, Kim HC, Chung JW, Han JK, et al. Small (≤ 1 cm) hepatocellular carcinoma: diagnostic performance and imaging features at gadoxetic acid-enhanced MR imaging. Radiology. 2014;271:748–60.

    Article  PubMed  Google Scholar 

  31. Golfieri R, Renzulli M, Lucidi V, Corcioni B, Trevisani F, Bolondi L. Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤ 2 cm) HCC in cirrhosis. Eur Radiol. 2011;21:1233–42.

    Article  PubMed  Google Scholar 

  32. Kogita S, Imai Y, Okada M, Kim T, Onishi H, Takamura M, et al. Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow. Eur Radiol. 2010;20:2405–13.

    Article  PubMed  Google Scholar 

  33. Goncalves Neto JA, Altun E, Elazzazi M, Vaidean GD, Chaney M, Semelka RC. Enhancement of abdominal organs on hepatic arterial phase: quantitative comparison between 1.5- and 3.0-T magnetic resonance imaging. Magn Reson Imaging. 2010;28:47–55.

    Article  PubMed  Google Scholar 

Download references

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150 Seongan-ro Gangdong-Gu, Seoul, 134-701, South Korea

    Ji Yoon Moon

  2. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, 135-710, South Korea

    Seong Hyun Kim

  3. Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Kyunggi-do, South Korea

    Seo-Youn Choi & Ji Eun Lee

  4. Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, South Korea

    Jeong Ah Hwang

  5. Department of Radiology, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, South Korea

    Jisun Lee

Authors
  1. Ji Yoon Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seong Hyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seo-Youn Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeong Ah Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ji Eun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jisun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seong Hyun Kim.

Ethics declarations

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.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moon, J.Y., Kim, S.H., Choi, SY. et al. 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. Jpn J Radiol 36, 489–499 (2018). https://doi.org/10.1007/s11604-018-0748-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-018-0748-x

Keywords

Search

Navigation