New hallmark of hepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm

Abstract

Our new diagnostic algorithm demonstrated significantly higher sensitivity and comparable specificity than those of the AASLD imaging criteria for HCC in patients with cirrhosis evaluated using Gd-EOB-DTPA MRI, even for lesions ≤2 cm. Moreover, this diagnostic algorithm allowed evaluating other lesions which could arise in a cirrhotic liver, such as early HCC and HGDN.

Diagnosis of hepatocellular carcinoma with MRI

“…However, these traditional imaging protocols seem to be applicable worldwide, as prerequisites for ensuring a good and robust imaging procedure are low with a simple contrast-enhanced CT scan allowing adequate evaluation of the dynamic contrast behaviour of a liver lesion. In contrast, the algorithm proposed by Renzulli et al 7 requires MRI and the use of a hepatocyte-specific contrast agents. These are limitations that may hinder widespread adoption of this improved algorithm, especially since MRI is not widely available worldwide and hepatocyte-specific contrast agents are currently much more expensive than all other extracellular contrast agents.…”

“…Based on these findings, Renzulli et al 7 recently conducted a prospective study on patients with a chronic liver disease at risk for HCC undergoing surveillance ultrasound. All patients had at least one hepatic nodule >1 cm in size and were referred to dynamic MRI.…”

“…The results of Renzulli et al 7 are very promising as they overcome the major limitation of low sensitivity in detecting HCC using the non-invasive imaging criteria proposed by different guidelines. However, these traditional imaging protocols seem to be applicable worldwide, as prerequisites for ensuring a good and robust imaging procedure are low with a simple contrast-enhanced CT scan allowing adequate evaluation of the dynamic contrast behaviour of a liver lesion.…”

“…A major advantage of the three imaging criteria proposed by Renzulli et al 7 is that they do not rely on evaluation of contrast agent washout in the venous contrast phase. However, this avoids the problem of a possible ‘pseudo-washout’ associated with hepatocyte-specific contrast medium during the venous or delayed phase when there is overlap between extracellular distribution and uptake into hepatocytes 9 10.…”

“…Moreover, there is the phenomenon that not all HCC lesions actually show a clear venous washout 11. In this way, Renzulli et al 7 directly solve the problem of low sensitivity for detecting small 1–2 cm HCC lesions when using the imaging algorithms in current guidelines, which mostly rely on the evaluation of venous washout. A further advantage of including DWI in the imaging protocol is that it may allow differentiation between high-grade dysplastic nodules and early HCC, as the authors observed a diffusion restriction in all early HCC lesions included in their study.…”