MRI of Small Hepatocellular Carcinoma: Typical Features Are Less Frequent Below a Size Cutoff of 1.5 cm

Choi, Moon Hyung; Choi, Joon Weon; Lee, Young Joon; Park, Michael Yong; Rha, Sung Eun; Lall, Chandana

doi:10.2214/ajr.16.16414

Cited by 30 publications

(26 citation statements)

References 24 publications

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“…Our results confirmed the data by Becker et al [ 26 ], that showed as the diameter and washout criteria using a step wise LI-RADS decision tree for LR3-5 observations allowed faster categorization with better inter-observer reliability while maintaining the excellent diagnostic accuracy of the most recent LI-RADS v2014. Choi et al [ 27 ] demonstrated as HCCs smaller than 15 mm showed typical finding of HCC less frequently than HCCs of 15 mm or larger in diameter. In subgroup analyses, HCCs with diameters between 10 and 15 mm showed similar MRI findings to HCCs with diameters of 10 mm or less but significantly different findings compared with HCCs with diameters from 15 to 20 mm and 20-30 mm.…”

Section: Discussionmentioning

confidence: 99%

Critical analysis of the major and ancillary imaging features of LI-RADS on 127 proven HCCs evaluated with functional and morphological MRI: Lights and shadows

et al. 2017

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PurposeTo report a critical analysis of major and ancillary MR imaging features in assessment of HCC.MethodsRetrospectively we evaluated 70 cirrhotic patients with 173 nodules, which were subjected to MR study at 0 time (MR0), after 3 (MR3) and 6 months (MR6) using two different contrast media. EOB-GD-DTPA was injected at MR0 and MR6, while Gd-BT-DO3A at MR3. Three expert hepatic radiologists reviewed all images, recording, according to LI-RADS, the size, the presence and quality of arterial-phase hyperenhancement, washout and capsule appearance, threshold growth. Additionally, we recorded signal intensity (SI) on T2-W images, on DWI, on apparent diffusion coefficient (ADC) maps and SI on T1-W images of EOB-GD-BPTA hepatospecific phase. Median value of ADC and of Intravoxel incoherent motion related parameters were assessed.Results127 HCCs and 24 dysplastic nodules were assessed. Hypervascular on arterial phase was found in 84 HCCs, washout appearance in 124, capsule appearance in 111, hypointensity on hepatospecific phase in 127, hyperintensity on T2-W sequences and restricted diffusion in 107. Hyper vascular on arterial phase was found in 17 dysplastic nodules, wash-out appearance in 2, hypointensity on hepatospecific phase in 7 while no dysplastic nodules showed capsule appearance, hyperintensity on T2-W and restricted diffusion. Highest accuracy was obtained by washout appearance and hypointense signal on hepatospecific phase (97% and 95%).ConclusionsHypointensity on hepatospecific phase and washout appearance are the most relevant diagnostic sign for differentiating low-risk from high-risk HCC nodules. The capsule appearance, T2-W hyperintensity and restricted diffusion have high positive predictive value.

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Section: Discussionmentioning

confidence: 99%

Critical analysis of the major and ancillary imaging features of LI-RADS on 127 proven HCCs evaluated with functional and morphological MRI: Lights and shadows

et al. 2017

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“…The diagnostic superiority of CEUS compared to more elaborate cross-sectional imaging modalities for smaller HCC lesions was previously described. A retrospective study found out that typical morphological HCC-features were less frequently registered by MRI than visualized by CEUS [ 33 ]. Furthermore, the cost-effectiveness of CEUS in the context of HCC surveillance was previously described [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Advanced Fusion Imaging and Contrast-Enhanced Imaging (CT/MRI–CEUS) in Oncology

Schwarze

Rübenthaler

Marschner

et al. 2020

Cancers

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Fusion imaging depicts an innovative technique that facilitates combining assets and reducing restrictions of advanced ultrasound and cross-sectional imaging. The purpose of the present retrospective study was to evaluate the role of fusion imaging for assessing hepatic and renal lesions. Between 02/2011–08/2020, 92 patients in total were included in the study, of which 32 patients had hepatic lesions, 60 patients had renal lesions. Fusion imaging was technically successful in all patients. No adverse side effects upon intravenous (i.v.) application of SonoVue® (Bracco, Milan, Italy) were registered. Fusion imaging could clarify all 11 (100%) initially as indeterminate described hepatic lesions by computed tomography/magnetic resonance imaging (CT/MRI). Moreover, 5/14 (36%) initially suspicious hepatic lesions could be validated by fusion imaging, whereas in 8/14 (57%), malignant morphology was disproved. Moreover, fusion imaging allowed for the clarification of 29/30 (97%) renal lesions initially characterized as suspicious by CT/MRI, of which 19/30 (63%) underwent renal surgery, histopathology revealed malignancy in 16/19 (84%), and benignity in 3/19 (16%). Indeterminate findings could be elucidated by fusion imaging in 20/20 (100%) renal lesions. Its accessibility and repeatability, even during pregnancy and in childhood, its cost-effectiveness, and its excellent safety profile, make fusion imaging a promising instrument for the thorough evaluation of hepatic and renal lesions in the future.

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“…A study by Forner et al [ 18 ] presents low sensitivity (61.7% for MRI) for lesions < 20mm. In Choi et al [ 19 ] study the cutoff point was set at 1.5cm; the lesions below this threshold less frequently showed MRI features typical for HCC. All classifications systems or guidelines take the lesion's diameter into consideration but with various cutoff points.…”

Section: Discussionmentioning

confidence: 99%

Comparison of LI-RADS v.2017 and ESGAR Guidelines Imaging Criteria in HCC Diagnosis Using MRI with Hepatobiliary Contrast Agents

Rosiak

Podgórska

Rosiak

et al. 2018

BioMed Research International

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Purpose The purpose of this study was to assess and compare diagnostic ability of LI-RADS (LR) v. 2017 and ESGAR guidelines in hepatocellular carcinoma (HCC) diagnosis using MRI with hepatobiliary contrast agents. Methods Seventy pathologically confirmed lesions in 32 patients (24 males and 8 females) who had MRI with hepatobiliary contrast done before surgery or biopsy were reviewed retrospectively. Six lesions were <10mm, 31 lesions 10-19mm, and 33 lesions ≥20mm. Two readers assessed all lesions according to LI-RADS v.2017 criteria and ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Statistical analysis was performed to compare diagnostic ability of both guidelines including receiver operative curves (ROC) and area under curve (AUC). Results For LR ≥ 4 sensitivity, specificity, accuracy, and AUC were 96%, 75%, 88.6%, and 85.5, respectively. For LR5 they were 74%, 95%, 80%, and 84.5, respectively. For ESGAR criteria with major and additional features, they were 88%, 75%, 84.3%, and 81.5, respectively. For ESGAR criteria only with major features they were 78%, 80%, 78.6%, and 79, respectively. AUC analysis revealed that overall diagnostic ability of LI-RADS was higher than ESGAR but the results did not show statistical significance. Conclusions Both LI-RADS and ESGAR guidelines presented high diagnostic ability in HCC diagnosis of MRI studies with hepatobiliary contrast agents. More complex LI-RADS criteria performed better than ESGAR guidelines and it may justify extra effort that needs to be put in the report. However, the results were not statistically different and the simplicity of the ESGAR guidelines should also be taken into consideration.

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MRI of Small Hepatocellular Carcinoma: Typical Features Are Less Frequent Below a Size Cutoff of 1.5 cm

Abstract: HCCs smaller than 1.5 cm in size less frequently showed MRI findings seen typically in larger HCCs. Therefore, small HCCs are harder to detect with certainty not only because of small size but also because of the lower frequency of typical MRI findings.

Cited by 30 publications

References 24 publications

Critical analysis of the major and ancillary imaging features of LI-RADS on 127 proven HCCs evaluated with functional and morphological MRI: Lights and shadows

Critical analysis of the major and ancillary imaging features of LI-RADS on 127 proven HCCs evaluated with functional and morphological MRI: Lights and shadows

Advanced Fusion Imaging and Contrast-Enhanced Imaging (CT/MRI–CEUS) in Oncology

Comparison of LI-RADS v.2017 and ESGAR Guidelines Imaging Criteria in HCC Diagnosis Using MRI with Hepatobiliary Contrast Agents

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