Detection of small hepatocellular carcinoma using gadoxetic acid‐enhanced <scp>MRI</scp>: Is the addition of diffusion‐weighted <scp>MRI</scp> at 3.0<scp>T</scp> beneficial?

Zhao, Xiang; Li, Wei Xia; Chai, Wei; Chen, Ke Min

doi:10.1111/1751-2980.12119

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…It has actually become common to encounter cases where hypervascular HCC or nodule-in-nodule HCC that is undetectable by MDCT is detected in a routine screening by EOB-MRI because of early enhancement in the arterial phase or clear hypointensity in the hepatobiliary phase [11,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103]. Furthermore, studies comparing the diagnostic performance of EOB-MRI and MDCT for hypervascular HCC have shown that EOB-MRI is superior or, at the very l...…”

Section: Diagnostic Algorithmmentioning

confidence: 99%

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

et al. 2014

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Surveillance and diagnostic algorithms for hepatocellular carcinoma (HCC) have already been described in guidelines published by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver and the European Organisation for Research and Treatment of Cancer (EASL-EORTC), and the Japan Society of Hepatology (JSH), but the content of these algorithms differs slightly. The JSH algorithm mainly differs from the other two algorithms in that it is highly sophisticated and considers the functional imaging techniques of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (EOB-MRI) and Sonazoid contrast-enhanced ultrasound (CEUS) to be very important diagnostic modalities. In contrast, the AASLD and EASL-EORTC algorithms are less advanced and suggest that a diagnosis be made based solely on hemodynamic findings using dynamic CT/MRI and biopsy findings. A consensus meeting regarding the JSH surveillance and diagnostic algorithm was held at the 50th Liver Cancer Study Group of Japan Congress, and a 2014 update of the algorithm was completed. The new algorithm reaffirms the very important role of EOB-MRI and Sonazoid CEUS in the surveillance and diagnosis of liver cancer and is more sophisticated than those currently used in the United States and Europe. This is now an optimized algorithm that can be used to diagnose early-stage to classical HCC easily and highly accurately.

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Section: Diagnostic Algorithmmentioning

confidence: 99%

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

et al. 2014

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“…Through the dynamic enhanced scan of patients, physicians could identify small lesions in the liver as early as possible, and its detection rate for atypical hyperplastic nodules is superior to that of enhanced CT scan (22,23). In this study, the diagnostic rate of MRI for SHCC was as high as 98.45%, and its diagnostic rate for MHCC reached 96.29%.…”

Section: Discussionmentioning

confidence: 64%

Study on the diagnosis of small hepatocellular carcinoma caused by hepatitis B cirrhosis via multi‑slice spiral CT and MRI

et al. 2017

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Abstract. The present study compared the diagnostic accuracy of multi-slice spiral computed tomography (CT) and magnetic resonance imaging (MRI) on small hepatocellular carcinoma (SHCC) caused by hepatitis B cirrhosis. A total of 160 patients with hepatitis B cirrhosis were selected between January 2012 and April 2016, and 183 SHCC lesions were included in the present retrospective study. Patients were divided into the SHCC group (T stage) and the micro hepatocellular carcinoma (MHCC) group (T1 stage). There were a total of 129 SHCC lesions and 54 MHCC lesions identified. All patients underwent multiphasic CT and MRI imaging. The liver acquisition with volume acquisition (LAVA) technique was utilized for MRI. Furthermore, SPSS 20.0 was used for statistical analyses. LAVA in the arterial phase and CT in the arterial phase revealed significantly higher diagnostic rates for the diagnoses of 183 lesions. In addition, standard CT scan exhibited significantly reduced diagnostic rates in SHCC lesions. Results indicated that LAVA in the equilibrium phase had the lowest diagnostic rate in MHCC lesions, which was statistically significant (P<0.05). Overall, the diagnostic rate of CT (79.63%) for MHCC was significantly lower than that of MRI (96.29%) (P<0.05). However, the diagnostic rate of CT for SHCC (96.12%) was significantly higher than that for MHCC (79.63%) (P<0.05). MRI-LAVA in the arterial phase has the highest diagnostic rate for SHCC and MHCC. However, the diagnostic capability of MRI for MHCC lesions is superior to that of CT. IntroductionLiver cancer is one of the most common malignant tumors of the digestive system. It has high incidence rates and ranks second in cancer mortality in China (1). It has multiple causes, such as liver cirrhosis, viral infection, chemical carcinogens, alcohol and tobacco, water pollution, and genetic factors (2). Liver cancer caused by hepatitis B infection and cirrhosis is highly prevalent, although it lacks the typical clinical manifestations of liver cancer Moreover, it is particularly important to improve the diagnostic rate of early liver cancer (3). The clinical diagnosis of the hepatocellular cancer involves multiple approaches. Important clinical symptoms like abdominal distension, liver pain, fever, emaciation, debilitation, and jaundice confirms the middle and advanced stage of the disease. The clinically well-established factor being utilized for liver cancer is cirrhosis (4). The diagnosis of hepatocellular carcinoma could frequently, and uniquely, be made on characteristic multiphase contrast based cross-sectional imaging rather than strict need for tissue sampling. Epigentics is another new area showing good potential in clincal diagnosis of liver cancer. Promising results from microRNA (miRNA/miR) profiling and hypermethylation of selected genes have raised hopes of identifying new biomarkers (5). Furthermore, miR-122, a completely conserved liver-specific miRNA in vertebrates, is essential for the maintenance of liver homeostasis. miR-122 is also being explored for...

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“…There have been studies which yielded opposing results regarding the role of DWI in the detection of small HCCs [9, 24, 28–30]. Park et al reported improved sensitivity for detecting small HCCs by adding DWI to gadoxetic acid-enhanced, dynamic MR imaging and which increased the sensitivity from 80.5–82.1% to 91.1%—93.3% [24].…”

Section: Discussionmentioning

confidence: 99%

“…However, as that study was also conducted on HCCs less than 2 cm in diameter their results may, therefore, may not apply to lesions ≤ 1 cm in diameter [29]. A few other studies have also demonstrated questionable results regarding DWI for detecting small HCCs, as in these studies conventional dynamic MR showed superior results to those of DWI or the addition of DWI had no diagnostic benefit [9, 30]. These unfavorable results of DWI regarding small HCCs could be explained by the following: as the tissue structure of HCC is similar to that of the surrounding cirrhotic liver, it can be difficult to differentiate an HCC from cirrhotic parenchyma [24]; the background cirrhotic liver parenchyma may show diffusion restriction [31]; and there is a limited signal-to-noise ratio and spatial resolution with susceptibility to motion artifacts [32].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma and the concordance rate of Liver Imaging Reporting and Data System (LI-RADS)

Bae

Lee

et al. 2017

PLoS ONE

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Background & aimsTo assess diagnostic accuracy of gadoxetic acid–enhanced MR for small hypervascular hepatocellular carcinoma (HCC) detected by C-arm CT and concordance rate of Liver Imaging Reporting and Data System (LI-RADS).MethodsIn this retrospective study, we recruited 4,544 patients suspected of having HCC underwent C-arm CT from November 2008 to May 2013. Among these patients, gadoxetic acid–enhanced MR was performed in 167 patients with HCC (n = 379; 257 > 1 cm, 122 ≤ 1 cm). HCC was confirmed by MR, CT, or follow-up images. Two radiologists graded likelihood of HCC and assessed MR features. Jackknife alternative free-response receiver operating characteristic (JAFROC) analysis was performed. All HCCs were evaluated concordance rate of LI-RADS.ResultsMean JAFROC figure of merit for large (>1-cm) HCC was 0.948, while that for small HCC was 0.787 with fair agreement (κ = 0.409). Mean sensitivity and positive predictive value (PPV) were 91% and 90% for large HCC versus 63.0% and 79% for small HCC, respectively. Seventeen of 122 small HCCs (13.9%) were not visible on MR. Among 379 HCCs, 99 met LR-5, and 259 met LR-4. Common features for small HCC included arterial enhancement (81.9%), hepatobiliary phase hypointensity (80.3%), and delayed washout (72.9%).ConclusionDiagnostic accuracy of gadoxetic acid–enhanced MR imaging for small, hypervascular HCCs (Mean figure of merit = 0.787) was still low compared with large HCC (Mean figure of merit = 0.948). LR-5 and LR-4 covered 94% (358/379) of the HCCs.

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Detection of small hepatocellular carcinoma using gadoxetic acid‐enhanced MRI: Is the addition of diffusion‐weighted MRI at 3.0T beneficial?

Abstract: There is no benefit in adding DWI to gadoxetic acid-enhanced MRI for the detection of HCC at 3.0T.

Cited by 13 publications

References 34 publications

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

Study on the diagnosis of small hepatocellular carcinoma caused by hepatitis B cirrhosis via multi‑slice spiral CT and MRI

Diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma and the concordance rate of Liver Imaging Reporting and Data System (LI-RADS)

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