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Differentiation of small (≤2 cm) hepatocellular carcinomas from small benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance images

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Abstract

Objective

To identify imaging characteristics that differentiate small (≤2 cm) HCCs from small (≤2 cm) benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted (DW) magnetic resonance (MR) images.

Materials and methods

On gadoxetic acid-enhanced and DW MR images, we analysed signal intensity of 222 small HCCs and 61 benign nodules (diameter, 0.5–2 cm) at each sequence and rim enhancement during portal or equilibrium phases. Univariate and multivariate logistic regression analyses identified predictors of HCC. Combinations of significant MR findings in multivariate analysis were compared with American Association for the Study of Liver Disease (AASLD) practice guidelines.

Results

In multivariate analysis, arterial enhancement (adjusted odds ratio [aOR], 8.6), T2 hyperintensity (aOR, 5.8), and hyperintensity on DW images (aOR, 3.8) were significant for differentiating small HCCs from benign nodules (p ≤ 0.004). When two or all three findings were applied as diagnostic criteria for differentiating small HCCs from benign nodules, sensitivity and accuracy were significantly higher compared with AASLD practice guidelines (91% vs. 78% and 89% vs. 81%, respectively; each p < 0.0001).

Conclusion

On gadoxetic acid-enhanced MR imaging, arterial enhancement and hyperintensity on T2-weighted and DW MR images are helpful for differentiating small HCCs from benign nodules in liver cirrhosis.

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Acknowledgments

The authors thank Dr. Hwa Jung Kim for help with statistics.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-ku, Seoul, 138-736, Korea

    Heon-Ju Kwon, Jae Ho Byun, Ji Yeon Kim, Gil-Sun Hong, Hyung Jin Won, Yong Moon Shin & Pyo Nyun Kim

  2. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-dong, Jongno-gu, Seoul, 110-746, Korea

    Heon-Ju Kwon

  3. Department of Radiology, vievis NAMUH hospital, 94-22 Nonhyun-dong, Gangnam-gu, Seoul, 135-010, Korea

    Ji Yeon Kim

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  1. Heon-Ju Kwon
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Correspondence to Jae Ho Byun.

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Kwon, HJ., Byun, J.H., Kim, J.Y. et al. Differentiation of small (≤2 cm) hepatocellular carcinomas from small benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance images. Abdom Imaging 40, 64–75 (2015). https://doi.org/10.1007/s00261-014-0188-8

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