Diagnosis of Hepatocellular Carcinoma with Gadoxetic Acid-Enhanced MRI: 2016 Consensus Recommendations of the Korean Society of Abdominal Radiology

Ahn, Jhii Hyun; An, Chansik; Choi, Jin Young; Choi, Joon Il; Joo, Ijin; Kang, Tae Wook; Kim, Dae Jung; Kim, Do Young; Kim, Seong Hyun; Kim, So Yeon; Kim, Young Kon; Lee, Changhee; Lee, Eun Sun; Lee, Jeong Eun; Lee, Jeong Min; Lee, Min Hee; Lee, Seung Soo; Lee, Won Jae; Lee, Young Hwan; Park, Hee Sun; Park, Mi‐Suk; Park, Yang Shin; Shin, Sang Soo; Yoon, Jeong Hee; Yu, Eunsil

doi:10.3348/kjr.2017.18.3.427

Cited by 43 publications

(18 citation statements)

References 111 publications

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“…HCC was diagnosed by surgical resection or liver transplantation in 37 patients and biopsy in 5 patients. In the remaining patients, the diagnosis of HCC was based on the radiological hallmarks of AASLD, or the Korean Liver Cancer Study Group-National Cancer Center Korea (KLCSG-NCC), namely the arterial enhancement and washout on the portal venous or transitional phases ( 8 6 11 12 ). HCCs smaller than 1 cm were diagnosed based on the imaging findings in the same manner according to the KLCSG-NCC guidelines ( 11 ).…”

Section: Methodsmentioning

confidence: 99%

The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study

et al. 2018

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ObjectiveTo preliminarily evaluate the diagnostic performance of an unenhanced MRI for detecting hepatocellular carcinoma (HCC) with a case-control study design.Materials and MethodsThe case group consisted of 175 patients with initially-diagnosed HCC, who underwent a 3T liver MRI. A total of 237 HCCs were identified. The number of HCCs that were smaller than 1 cm, 1 cm ≤ and < 2 cm, and ≥ 2 cm were 19, 105, and 113, respectively. For the control group, 72 patients with chronic liver disease, who did not have HCC, were enrolled. Two radiologists independently reviewed the T2 half-Fourier acquisition single-shot turbo spin echo, T2 fast spin echos with fat saturation, T1 gradient in- and out-of-phase images, and diffusion-weighted images/apparent diffusion coefficient maps to detect HCC. Per-patient analyses were performed to evaluate the sensitivity and specificity of the non-contrast MRI for diagnosing HCC. Furthermore, the per-lesion sensitivity was also calculated according to tumor size.ResultsIn the per-patient analyses, the sensitivity and specificity of reader 1 were 86.3% (151/175) and 87.5% (63/72), respectively; while those of reader 2 were 82.9% (145/175) and 76.4% (55/72), respectively. When excluding HCCs smaller than 1 cm, the sensitivity of reader 1 and 2 were 88.0% (147/167) and 86.2% (144/167), respectively. In the per-lesion analyses, the sensitivities of reader 1 and reader 2 were 75.9% (180/237) and 70.5% (167/237), respectively.ConclusionThe per-patient sensitivity and specificity of non-contrast MRIs were within a reasonable range for the initial diagnosis of HCC. Non-contrast MRIs may have a potential for surveillance of HCC. Further confirmatory diagnostic test accuracy studies are needed.

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Section: Methodsmentioning

confidence: 99%

The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study

et al. 2018

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“…Diffusion restriction, mosaic architecture, nodule-in-nodule appearance, and rim enhancement can be suggested as ancillary imaging findings of HCC (518). However, arterial hyperenhancement and portal or delayed wash-out are the most important imaging characteristics based on the unique histopathological features of HCC, which is increased unpaired arterial blood flow with decreased portal flow during hepato-carcinogenesis (719).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a previous study reported that the utility of unenhanced CT images was improved with the detection of arterial hyperenhancement of HCC (8). Therefore, the definition of arterial enhancement for HCC diagnosis in CT images should be established differently unlike current clinical guidelines (12345) due to insufficient identification rate of arterial enhancement.…”

Section: Discussionmentioning

confidence: 99%

“…Third, we did not consider the cost-effectiveness of each test or the radiation issues caused by additional acquisition of an unenhanced CT scan. More evidence provided through prospective trials is needed to optimize the definition of detection for arterial hyper-enhancement of HCCs in patients with chronic liver disease beyond the current clinical guidelines (12345).…”

Section: Discussionmentioning

confidence: 99%

“…Given the varied prevalence and clinical settings, there has been some heterogeneity in the clinical guidelines regarding the method of imaging diagnosis for hepatocellular carcinoma (HCC) (123456). However, all methods used to diagnose HCC are based on the imaging diagnostic hallmarks of arterial enhancement and portal-delayed washout, as key alterations during hepatocarcinogenesis include elevated arterial flow and reduced portal venous flow (7).…”

Section: Introductionmentioning

confidence: 99%

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Identification of Arterial Hyperenhancement in CT and MRI in Patients with Hepatocellular Carcinoma: Value of Unenhanced Images

Kim

Kang

et al. 2019

Korean J Radiol

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ObjectiveAccording to the current guidelines, arterial hyperenhancement for diagnosis of hepatocellular carcinoma (HCC) is determined using the arterial phase only. We investigated the optimal definition of arterial hyperenhancement in patients with HCC using computed tomography (CT) and magnetic resonance imaging (MRI).Materials and MethodsThe Institutional Review Board approved this retrospective study. The requirement for informed consent was waived. Between January 2011 and September 2013, 147 consecutive patients with surgically proven HCCs with both pre-operative CT and MRI were included. Identification rates of arterial hyperenhancement on CT and magnetic resonance (MR) images using arterial phase only, dual phase (unenhanced and arterial phases), and also subtraction MR images were assessed qualitatively.ResultsThe identification rates for arterial hyperenhancement on CT were significantly different between arterial phase and dual phase (72.8% vs. 90.5%; p < 0.001), whereas the rates were similar on MRI (91.8% vs. 93.9%; p = 0.257). The identification rate of arterial hyperenhancement in MRI increased to 98.6% using subtraction MR images.ConclusionVisual comparison of arterial and unenhanced phases could be recommended instead of conventional qualitative arterial phase alone assessment to determine arterial hyperenhancement of HCCs, especially when using CT.

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Value of gadoxetic acid‐enhanced MRI and diffusion‐weighted imaging in the differentiation of hypervascular hyperplastic nodule from small (<3 cm) hypervascular hepatocellular carcinoma in patients with alcoholic liver cirrhosis: A retrospective case–control study

Kim

Song

Choi

et al. 2019

Magnetic Resonance Imaging

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Background: Hypervascular hyperplastic nodules (HHNs) occasionally develop in patients with alcoholic liver cirrhosis (ALC) and show arterial enhancement, thus mimicking hepatocellular carcinoma (HCC). Importantly, HHN as a benign lesion should be distinguished from HCC. Purpose: To evaluate the value of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) and diffusion-weighted imaging (DWI) in distinguishing HHN from small (<3 cm) hypervascular HCC (hHCC) in patients with ALC. Study Type: Retrospective case-control study. Field Strength/Sequence: 3.0T/in-and out-of-phase, T 1 -weighted, T 2 -weighted, diffusion-weighted, apparent diffusion coefficient, and dynamic gadoxetic acid-enhanced images. Population: Among 560 patients with ALC who underwent Gd-EOB-MRI and DWI, 12 patients with 28 HHNs and 22 patients with 29 hHCCs smaller than 3 cm were included. Assessment: The following MRI features were evaluated by three independent radiologists: signal intensity (SI) on T 1 -weighted, T 2 -weighted, diffusion-weighted, and hepatobiliary phase (HBP) images; shape, homogeneity, and margin on HBP; diffusion restriction; intralesional fat; necrosis; hemorrhage; washout on portal venous phase (PVP) and/or transitional phase (TP); and capsular enhancement. Quantitative analysis was also conducted. Statistical Tests: Univariate and multivariate analyses were performed to determine the significant MRI findings, and their diagnostic performance for the prediction of HHN was analyzed. Results: Lesion size of ≤16 mm (odds ratio [OR], 24.41; P = 0.007), low-to-iso SI on DWI (OR, 26.92; P = 0.007), and absence of washout on PVP and/or TP (OR, 31.84; P = 0.009) were significant independent factors for predicting HHN. When all three criteria were satisfied, the specificity was 100%. Compared with hHCCs, HHNs showed significantly smaller View this article online at wileyonlinelibrary.com.

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Diagnosis of Hepatocellular Carcinoma with Gadoxetic Acid-Enhanced MRI: 2016 Consensus Recommendations of the Korean Society of Abdominal Radiology

Cited by 43 publications

References 111 publications

The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study

The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study

Identification of Arterial Hyperenhancement in CT and MRI in Patients with Hepatocellular Carcinoma: Value of Unenhanced Images

Value of gadoxetic acid‐enhanced MRI and diffusion‐weighted imaging in the differentiation of hypervascular hyperplastic nodule from small (<3 cm) hypervascular hepatocellular carcinoma in patients with alcoholic liver cirrhosis: A retrospective case–control study

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