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Added value of subtraction imaging in detecting arterial enhancement in small (<3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To determine the importance of arterial enhancement in diagnosing small (<3 cm) hepatocellular carcinomas (HCCs) and to evaluate the added value of dynamic subtraction magnetic resonance imaging (MRI) in detecting arterial enhancement in small (<3 cm) hepatic nodules in high-risk patients.

Methods

Eighty-six patients with 135 pathologically confirmed small (<3 cm) hepatic nodules (104 HCCs, 31 benign nodules) underwent MRI before curative surgery. Arterial enhancement was determined by three methods: (1) visual assessment of the arterial phase alone, (2) visual comparison of the arterial phase with the unenhanced phase and (3) additional review of subtraction images. The diagnostic performance of each method was calculated and compared using generalised estimating equations analysis.

Results

Arterial enhancement demonstrated high positive predictive value (PPV) (96.5–98.9 %) and specificity (90.3–96.8 %), but low negative predictive value (NPV) (54.6–62.5 %) and intermediate sensitivity (76–79.8 %) for diagnosing small HCCs. Diagnostic performance was highest for subtraction imaging. There were significant differences among the three methods in sensitivity (P = 0.04), accuracy (P = 0.044), PPV (P < 0.001) and NPV (P = 0.024), but not in specificity (P = 0.167).

Conclusion

The accurate detection of arterial enhancement in small hepatic nodules is important for diagnosing HCC and may be enhanced by subtraction imaging.

Key Points

• Arterial enhancement in small hepatic nodules indicates a high probability of malignancy

• Dynamic subtraction MRI can enable more accurate detection of arterial enhancement

• Subtraction imaging could lead to earlier diagnosis of hepatocellular carcinoma

• More timely care for patients might be provided

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Abbreviations

HCC:

hepatocellular carcinoma

EASL:

European Association for the Study of the Liver

AASLD:

American Association for the Study of Liver Diseases

GRE:

gradient recalled echo

Gd-EOB-DTPA:

gadolinium-ethoxybenzyl-diethylenetriamine

PPV:

positive predictive value

NPV:

and negative predictive value

GEE:

Generalised estimating equations

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Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (7-2012-0290).

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Chansik An, Mi-Suk Park, Yeo-Eun Kim, Woo-Suk Chung, Hyungjin Rhee, Myeong-Jin Kim & Ki Whang Kim

  2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea

    Mi-Suk Park & Myeong-Jin Kim

  3. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Dowhan Kim

  4. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 120-752, South Korea

    Mi-Suk Park

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  1. Chansik An
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Correspondence to Mi-Suk Park.

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An, C., Park, MS., Kim, D. et al. Added value of subtraction imaging in detecting arterial enhancement in small (<3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma. Eur Radiol 23, 924–930 (2013). https://doi.org/10.1007/s00330-012-2685-x

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  • DOI: https://doi.org/10.1007/s00330-012-2685-x

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