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Maung ST, Tanpowpong N, Satja M, Treeprasertsuk S, Chaiteerakij R. MRI for hepatocellular carcinoma and the role of abbreviated MRI for surveillance of hepatocellular carcinoma. J Gastroenterol Hepatol 2024. [PMID: 38899804 DOI: 10.1111/jgh.16643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) constitutes the majority of liver cancers and significantly impacts global cancer mortality. While ultrasound (US) with or without alpha-fetoprotein is the mainstay for HCC surveillance, its limitations highlight the necessity for more effective surveillance tools. Therefore, this review explores evolving imaging modalities and abbreviated magnetic resonance imaging (MRI) (AMRI) protocols as promising alternatives, addressing challenges in HCC surveillance. AREAS COVERED This comprehensive review delves into the evaluation and challenges of HCC surveillance tools, focusing on non-contrast abbreviated MRI (NC-AMRI) and contrast-enhanced abbreviated MRI protocols. It covers the implementation of AMRI for HCC surveillance, patient preferences, adherence, and strategies for optimizing cost-effectiveness. Additionally, the article provides insights into prospects for HCC surveillance by summarizing meta-analyses, prospective studies, and ongoing clinical trials evaluating AMRI protocols. EXPERT OPINION The opinions underscore the transformative impact of AMRI on HCC surveillance, especially in overcoming US limitations. Promising results from NC-AMRI protocols indicate its potential for high-risk patient surveillance, though prospective studies in true surveillance settings are essential for validation. Future research should prioritize risk-stratified AMRI protocols and address cost-effectiveness for broader clinical implementation, alongside comparative analyses with US for optimal surveillance strategies.
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Affiliation(s)
- Soe Thiha Maung
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Ma Har Myaing Hospital, Yangon, Myanmar
| | - Natthaporn Tanpowpong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Minchanat Satja
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Steatohepatitic hepatocellular carcinoma: imaging findings with clinicopathological correlation. Clin Radiol 2020; 76:160.e15-160.e25. [PMID: 33046228 DOI: 10.1016/j.crad.2020.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 09/08/2020] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the clinicopathological and computed tomography (CT) and magnetic resonance imaging (MRI) findings of steatohepatitic hepatocellular carcinoma (SH-HCC). MATERIALS AND METHODS Clinicopathological and radiological features were evaluated in 20 patients with SH-HCC. The diagnosis of SH-HCC was made histologically if the tumour had four of the following five characteristics: steatosis (>5% tumour cells), ballooning, Mallory-Denk bodies, interstitial fibrosis, and inflammation. All patients underwent dynamic CT and MRI. CT and MRI images were reviewed for morphological features including tumour size, presence, and distribution of fat, and patterns and degree of contrast enhancement. RESULTS Obesity, hypertension, and history of heavy alcohol intake were common clinical findings observed in 10 (50%), 13 (65%), and 11 (55%) of the 20 patients, respectively. Steatosis and steatohepatitis were pronounced in the background liver in 12 (60%) and 10 (50%) patients, respectively. SH-HCC was moderately differentiated in 18 patients (90%) and well differentiated in two (10%). Pathologically, steatohepatitic features were diffuse in 12 (60%) of the 20 tumours and focal in eight (40%). Tumour size and the percentage of intratumoural steatosis were not correlated (r=0.17, p=0.47). On CT, 16 (80%) patients showed arterial phase enhancement and delayed washout. On MRI, 16 (80%) of 20 tumours showed prominent fatty deposition (10 diffusely, six focally) with arterial phase enhancement. CONCLUSIONS SH-HCC is likely to show prominent fatty deposits with arterial phase enhancement on CT and MRI. A hypervascular lesion with prominent fatty change should raise the diagnostic suspicion of SH-HCC.
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Moon JY, Kim SH, Choi SY, Hwang JA, Lee JE, Lee J. 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 2018; 36:489-499. [PMID: 29876721 DOI: 10.1007/s11604-018-0748-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/28/2018] [Indexed: 01/04/2023]
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.
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Affiliation(s)
- Ji Yoon Moon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150 Seongan-ro Gangdong-Gu, Seoul, 134-701, South Korea
| | - Seong Hyun Kim
- 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.
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Kyunggi-do, South Korea
| | - Jeong Ah Hwang
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, South Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Kyunggi-do, South Korea
| | - Jisun Lee
- Department of Radiology, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, South Korea
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Chernyak V, Tang A, Flusberg M, Papadatos D, Bijan B, Kono Y, Santillan C. LI-RADS ® ancillary features on CT and MRI. Abdom Radiol (NY) 2018. [PMID: 28647768 DOI: 10.1007/s00261-017-1220-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) uses an algorithm to assign categories that reflect the probability of hepatocellular carcinoma (HCC), non-HCC malignancy, or benignity. Unlike other imaging algorithms, LI-RADS utilizes ancillary features (AFs) to refine the final category. AFs in LI-RADS v2017 are divided into those favoring malignancy in general, those favoring HCC specifically, and those favoring benignity. Additionally, LI-RADS v2017 provides new rules regarding application of AFs. The purpose of this review is to discuss ancillary features included in LI-RADS v2017, the rationale for their use, potential pitfalls encountered in their interpretation, and tips on their application.
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Affiliation(s)
| | - An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Demetri Papadatos
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Bijan Bijan
- Sutter Imaging (SMG)/University of California Davis (UCD), Sacramento, CA, USA
| | - Yuko Kono
- Department of Medicine, Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Cynthia Santillan
- Liver Imaging Group, Department of Radiology, University of California, San Diego, CA, USA
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Gadoxetate Disodium-Enhanced MRI to Differentiate Dysplastic Nodules and Grade of Hepatocellular Carcinoma: Correlation With Histopathology. AJR Am J Roentgenol 2015; 205:546-53. [PMID: 26295640 DOI: 10.2214/ajr.14.12716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of our study was to determine quantitative differences to differentiate low-grade from high-grade dysplastic nodules (DNs) and low-grade from high-grade hepatocellular carcinomas (HCCs) using gadoxetate disodium-enhanced MRI. MATERIALS AND METHODS A retrospective study of 149 hepatic nodules in 127 consecutive patients who underwent gadoxetic acid-enhanced MRI was performed. MRI signal intensities (SIs) of the representative lesion ROI and of ROIs in liver parenchyma adjacent to the lesion were measured on unenhanced T1-weighted imaging and on dynamic contrast-enhanced MRI in the arterial, portal venous, delayed, and hepatobiliary phases. The relative SI of the lesion was calculated for each phase as the relative intensity ratio as follows: [mass SI / liver SI]. RESULTS Of the 149 liver lesions, nine (6.0%) were low-grade DNs, 21 (14.1%) were high-grade DNs, 83 (55.7%) were low-grade HCCs, and 36 (24.2%) were high-grade HCCs. The optimal cutoffs for differentiating low-grade DNs from high-grade DNs and HCCs were an unenhanced to arterial SI of ≥ 0 or a relative SI on T2-weighted imaging of ≤ 1.5, with a positive predictive value (PPV) of 99.2% and accuracy of 88.6%. The optimal cutoffs for differentiating low-grade HCCs from high-grade HCCs were a relative hepatobiliary SI of ≤ 0.5 or a relative T2 SI of ≥ 1.5, with a PPV of 81.0% and an accuracy of 60.5%. CONCLUSION Gadoxetate disodium-enhanced MRI allows quantitative differentiation of low-grade DNs from high-grade DNs and HCCs, but significant overlap was seen between low-grade HCCs and high-grade HCCs.
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Rhee H, Kim MJ, Park YN, Choi JS, Kim KS. Gadoxetic acid-enhanced MRI findings of early hepatocellular carcinoma as defined by new histologic criteria. J Magn Reson Imaging 2011; 35:393-8. [PMID: 21990116 DOI: 10.1002/jmri.22828] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/06/2011] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To describe the imaging features of early hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI (Gd-EOB-MRI) in comparison with multidetector computed tomography (MDCT) examinations. MATERIALS AND METHODS We analyzed imaging findings of 19 pathologically proven early HCC lesions in 15 patients who underwent both MDCT and Gd-EOB-MRI at 3.0 Tesla (T) units before surgery. MRI included in-phase and out-of-phase T1-weighted dual-echo gradient-recalled-echo sequences, dynamic T1-weighted images before and after bolus injection of gadoxetic acid disodium, fat-saturated T2-weighted fast spin-echo sequences, and T1-weighted hepatobiliary phase images 20 min after contrast injection. Two radiologists retrospectively evaluated the signal intensities and enhancement features on MRI and MDCT. RESULTS None of the lesions displayed arterial enhancement and washout on MDCT. On Gd-EOB-MRI, six (32%) lesions showed T2-hyperintensity, five (26%) lesions showed signal drop on opposed-phase. Three lesions (16%) showed arterial enhancement and washout. Twelve (63%), 13 (68%), and 15 (79%) lesions were hypointense on hepatic venous, equilibrium, and hepatobiliary phase, respectively. CONCLUSION Most early HCCs did not show arterial enhancement and washout pattern on both MDCT and Gd-EOB-MRI. Gd-EOB-MRI may provide several ancillary findings for diagnosis of early HCC such as decreased hepatobiliary uptake, T2 hyperintensity and signal drop in opposed phase.
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Affiliation(s)
- Hyungjin Rhee
- Department of Radiology, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
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Saito K, Moriyasu F, Sugimoto K, Nishio R, Saguchi T, Nagao T, Taira J, Akata S, Tokuuye K. Diagnostic efficacy of gadoxetic acid-enhanced MRI for hepatocellular carcinoma and dysplastic nodule. World J Gastroenterol 2011; 17:3503-9. [PMID: 21941417 PMCID: PMC3163248 DOI: 10.3748/wjg.v17.i30.3503] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 03/07/2011] [Accepted: 03/14/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the relationship between the signal intensity of hepatobiliary phase images on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and histological grade.
METHODS: Fifty-nine patients with 82 hepatocellular lesions were evaluated retrospectively. Hepatobiliary phase images on gadoxetic acid-enhanced MRI were classified into 3 groups: low, iso or high. Angiography-assisted computed tomography (CT) findings were also classified into 3 groups: CT during arterial portography, and CT hepatic arteriography: A: iso, iso or low; B: slightly low, iso or low; and C: low, high. We correlated angiography-assisted CT, hepatobiliary phase findings during gadoxetic acid-enhanced MRI and histological grades. Furthermore, correlations between MRI findings and histological grade for each hemodynamic pattern were performed. Correlations among radiological and pathological findings were statistically evaluated using the chi-square test and Fisher’ s exact test.
RESULTS: There was a significant correlation between histological grade and hemodynamic pattern (P < 0.05). There was a significant correlation between histological grade and signal intensity in the hepatobiliary phase (P < 0.05) in group A lesions. There was no significant correlation between histological grade and signal intensity in the hepatobiliary phase in group B or C lesions (P > 0.05).
CONCLUSION: Signal intensity in the hepatobiliary phase correlated with histological grade in the lesions that maintained portal blood flow, but did not correlate in lesions that showed decreased or defective portal blood flow.
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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. [PMID: 21563246 DOI: 10.1002/jmri.22500] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the utility of gadoxetic acid-enhanced hepatocyte-phase magnetic resonance imaging (MRI) in characterization of T1-weighted hyperintense nodules within cirrhotic liver. MATERIALS AND METHODS This retrospective study was approved by our Institutional Review Board. Thirty-four nodules hyperintense in unenhanced T1-weighted MRI with histopathological confirmation from a collection of 19 patients were included. Tumor size, signal intensity on T1-weighted, and T2-weighted imaging as well as enhancement patterns on contrast-enhanced dynamic/hepatocyte-phase imaging were recorded. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of hepatocyte-phase imaging. RESULTS Evaluation of the nodules with standard of reference revealed 15 dysplastic nodules (DN), seven well-differentiated hepatocellular carcinomas (wHCC), and 12 moderately differentiated HCCs (mHCC). The mean size of dysplastic nodules was smaller than that of HCCs (P < 0.001). Using the HCC criteria (T2W or arterial enhancement followed with portal venous washout), 11/19 HCC were correctly characterized. Using solely hypointensity (compared to the surrounding liver parenchyma) during the hepatocyte phase as the criterion, 18/19 HCC were correctly characterized. There were seven additional HCCs diagnosed with hepatocyte-phase imaging (P = 0.02). CONCLUSION Gadoxetic acid-enhanced MRI with hepatocyte-phase imaging is superior to gadoxetic acid-enhanced MRI with conventional criteria alone in characterization of T1W hyperintense nodules.
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Affiliation(s)
- Chen-Te Chou
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan
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Chou CT, Chen YL, Su WW, Wu HK, Chen RC. Characterization of cirrhotic nodules with gadoxetic acid-enhanced magnetic resonance imaging: the efficacy of hepatocyte-phase imaging. J Magn Reson Imaging 2011; 32:895-902. [PMID: 20882620 DOI: 10.1002/jmri.22316] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the efficacy of hepatocyte-phase imaging (HP) in characterization of focal hepatic lesions in cirrhotic liver using gadoxetic acid-enhanced magnetic resonance imaging (MRI). METHODS A total of 66 nodules of 38 patients with liver cirrhosis undergoing gadoxetic acid-enhanced MRI were prospectively enrolled in this study. The histological examination revealed 15 dysplastic nodules (DNs), 7 well-differentiated hepatocellular carcinomas (wHCCs), and 44 moderately differentiated HCCs (mHCCs). Two imaging sets (Set A without HP, Set B with HP) were prepared to evaluate the efficacy of HP in lesion characterization. RESULTS The mean enhancement ratios (ERs) of mHCC were significantly increased in arterial phase followed by a subsequent decreased in hepatocyte phases. The mean ERs of wHCC were increased in dynamic study and followed by a plateau in the hepatocyte phase. The mean ERs of DNs were increased in dynamic study and hepatocyte phase. The mean liver-to-lesion contrasts of mHCCs were increased in arterial phase and HP (P < 0.05). wHCCs were only increased in HP (P < 0.05). DNs showed no significant difference in any phase (P > 0.05). There were seven additional HCCs that were detected in HP using imaging Set B compared to Set A. The diagnostic performance of Set B was significantly higher than that of Set A (P = 0.016). CONCLUSION The combination of gadoxetic acid-enhanced dynamic study and hepatocyte-phase T1WI may provide better diagnostic performance than only dynamic study in characterization of focal lesions in cirrhotic liver.
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Affiliation(s)
- Chen-Te Chou
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan
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Motosugi U, Ichikawa T, Sou H, Sano K, Tominaga L, Muhi A, Araki T. Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Radiology 2010; 256:151-8. [PMID: 20574092 DOI: 10.1148/radiol.10091885] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To retrospectively determine findings at gadoxetic acid-enhanced magnetic resonance (MR) imaging in hypervascular pseudolesions that were observed at computed tomography (CT) during hepatic arteriography, with special focus on distinguishing these pseudolesions from hypervascular hepatocellular carcinomas (HCCs). MATERIALS AND METHODS The institute ethics committee deemed study approval unnecessary. The study population comprised 80 patients (55 men, 25 women) with chronic liver disease who underwent CT during hepatic arteriography and arterial portography, gadoxetic acid-enhanced MR imaging, and follow-up dynamic contrast material-enhanced CT. The diagnosis of 104 pseudolesions and 123 HCCs was confirmed by means of histopathologic or multimodality evaluation. Two radiologists assessed the MR imaging findings of HCCs and pseudolesions in consensus, including the signal intensities (SIs) of the lesions on T2-weighted, diffusion-weighted (DW), and contrast-enhanced hepatocyte-phase images. The findings of nodular pseudolesions and HCCs were compared with the Fisher exact test. Additionally, the hepatocyte-phase SI ratio (ratio of lesion SI to liver SI) for HCCs and pseudolesions was compared by means of the Mann-Whitney U test. RESULTS There were 62 wedge-shaped, 32 nodular, and 10 linear pseudolesions. On gadoxetic acid-enhanced hepatocyte-phase MR images, 15% of pseudolesions (16 of 104) were hypointense compared with surrounding liver tissue. The mean hepatocyte-phase SI ratio of HCCs (0.65 +/- 0.14 [standard deviation]) was significantly lower (P < .01) than that of the nodular pseudolesions (0.95 +/- 0.11). The optimal cutoff value of hepatocyte-phase SI ratio for distinguishing between HCC and nodular pseudolesion was 0.84. No nodular pseudolesions were visible on DW images. CONCLUSION Gadoxetic acid-enhanced hepatocyte-phase MR imaging and DW imaging could be used to distinguish hypervascular pseudolesions from hypervascular HCCs; a hepatocyte-phase SI ratio below 0.84 and visibility on DW images were findings specific for HCCs rather than pseudolesions.
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Affiliation(s)
- Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
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Park HS, Lee JM, Kim SH, Chang S, Kim SJ, Han JK, Choi BI. Differentiation of well-differentiated hepatocellular carcinomas from other hepatocellular nodules in cirrhotic liver: value of SPIO-enhanced MR imaging at 3.0 Tesla. J Magn Reson Imaging 2009; 29:328-35. [PMID: 19161184 DOI: 10.1002/jmri.21615] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To determine the diagnostic value of superparamagnetic iron oxide (SPIO)-enhanced MRI for the differentiation of well-differentiated hepatocellular carcinomas (WD-HCCs) from other hepatocellular nodules in cirrhotic liver. MATERIALS AND METHODS This study included 114 patients with 216 histologically confirmed hepatocellular nodules, i.e., 23 dysplastic nodules (DNs), 37 WD-HCCs, and 156 moderately or poorly differentiated HCCs (MD-/PD HCCs), who underwent SPIO-enhanced MRI at 3.0T. MRI included T2-weighted fast-spin echo and T2*-weighted gradient recalled echo (GRE) sequences before and after administration of ferucarbotran. The contrast-to-noise ratio (CNR) of the lesion was calculated. Reviewers analyzed signal intensity (SI) of the nodules and their enhancement features on SPIO-enhanced images. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in the diagnosis of WD-HCC were also calculated. RESULTS The mean CNR of WD-HCC was significantly higher than that of DN on T2*-weighted image. Incomplete high SI on SPIO-enhanced T2*-weighted images were seen in 56.8% of WD-HCC. The most prevalent enhancement features of WD-HCCs on SPIO-enhanced T2*-weighted images, were iso SI with high SI foci [32.5% (12/37)] and homogenous subtle high SI [24.3% (9/37)]. Alternatively, 22 of 23 DNs (95.7%) showed low- or iso SI, and 145 of 156 (94.9%) MD-/PD HCCs showed strong high SI. When iso SI with high SI foci or subtle homogenous high SI nodule was considered as diagnostic criteria for WD-HCC, we could identify 56.8% of the WD-HCCs but only 4.4% of the DNs and 3.2% of the MD-/PD HCCs. CONCLUSION WD-HCCs have characteristic enhancement features that differentiate them from DNs and MD-/PD HCCs on SPIO-enhanced 3.0T MRI. The lesion conspicuity was better on T2*-weighted images than that on T2-weighted images.Inc.
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Affiliation(s)
- Hee Sun Park
- Department of Radiology, Seoul National University College of Medicine, Chongno-gu, Seoul, Korea
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Chen RC, Lii JM, Chou CT, Chang TA, Chen WT, Li CS, Tu HY. T2-weighted and T1-weighted Dynamic Superparamagnetic Iron Oxide (Ferucarbotran) Enhanced MRI of Hepatocellular Carcinoma and Hyperplastic Nodules. J Formos Med Assoc 2008; 107:798-805. [DOI: 10.1016/s0929-6646(08)60193-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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