A New Diagnostic Criterion with Gadoxetic Acid-Enhanced MRI May Improve the Diagnostic Performance for Hepatocellular Carcinoma

Abstract

Background: To prospectively establish and validate new diagnostic criterion (DC) for liverspecific contrast agents and further compared the diagnostic sensitivity and specificity with conventional DC. Methods: Institutional Review Board approved and written informed consent were obtained for this prospective study. Two board-certified reviewers established the reference standard as hepatocellular carcinoma (HCC), non-HCC lesions by using marks on all cross-sectional MR images. Another 2 abdominal radiologists independently performed the marked lesion observations using 5 different DCs, including DC-1: arterial phase hyperenhancement (APHE) and portal venous phase washout; DC-2: APHE and hepatobiliary phase (HBP) hypointensity; DC-3: APHE and diffusion-weighted imaging (DWI) hyperintensity; DC-4: HBP hypointensity and DWI hyperintensity; DC-5: HBP hypointensity, DWI hyperintensity and excluded these markedly T2 hyperintensity. Diagnostic performance of sensitivity, specificity, and accuracy for each imaging DC was calculated, per-lesion diagnostic sensitivity and specificity of imaging criteria were compared by using McNemars test. Results: A total of 215 patients were included (mean age 53.82 ± 11.24 years; range 24-82 years) with 265 hepatic nodules (175 HCCs and 90 non-HCCs). The DC-4 (93.71%; 164/175) and DC-5 (92.57%; 162/175) yielded the highest diagnostic sensitivity and was better than DC-1 (72.57%; 127/175), DC-2 (82.86%; 145/175), and DC-3 (82.29%; 144/175) (all p < 0.001). The specificity of DC-1 (94.44%;

Data‐Driven Modification of the LI‐RADS Major Feature System on Gadoxetate Disodium‐Enhanced MRI: Toward Better Sensitivity and Simplicity

“…EOB has become an important contrast agent for liver MRI worldwide, especially in East Asia. 3,10,11,17 Although first developed on MRI with extracellular agents, recent versions of LI-RADS have been adapted to include EOB. 20,34 However, the suboptimal detection of several major features (nonrim APHE, nonperipheral "washout," and enhancing "capsule") have constituted substantial barriers in applying the LI-RADS major feature system on EOB-MRI.…”

“…[7][8][9] As a result, investigators have explored possible solutions to improve the simplicity and diagnostic sensitivity of LI-RADS using various MR techniques and contrast agents. [9][10][11][12][13][14] However, many of these proposed modifications were based on investigator experiences, and limited data have been reported concerning the performances of the many available combinations of imaging features. Notably, there are strong data supporting the LI-RADS major features as the main determinants of HCC diagnosis, as reflected in the LI-RADS diagnostic table.…”

Surveillance, Diagnosis, and Treatment Outcomes of Hepatocellular Carcinoma in Japan: 2021 Update

“…Portal vein invasion was also less common in Japan than in other countries, but its incidence was higher than expected, occurring in 2,523 of 19,167 patients (13.2%) examined at the time of initial detection. This higher-than-expected incidence could be explained by recent advances in CT and MRI [51,52] and abdominal contrast-enhanced ultrasound [53], which have made minor vascular invasion graded as Vp1 or Vp2 clinically discernable from the time of initial detection for small HCCs.…”

Three-Dimensional Radiological Assessment of Ablative Margins in Hepatocellular Carcinoma: Pilot Study of Overlay Fused CT/MRI Imaging with Automatic Registration

“…Ablative margins were measured in a side-by-side manner. Part of the tumor was diagnosed as viable when images of the ablated area showed nodular peripheral enhancement [ 42 , 43 ].…”