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

Abstract

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.

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

“…The findings of our study also demonstrated that HBP hypointensity seems to be a more sensitive imaging feature for the diagnosis of HCC with the sensitivity of 97.14% (170/175); however, in our study, 5 HCCs (2.86%; 5/175) with well-differentiated characteristics presented hyperintensity on HBP and which lead to the false negative identification. In addition, it comes to our attention that the imaging feature of DWI hyperintensity entails a high diagnostic sensitivity of 96.00% (168/175) and which is obviously higher than that of the previous studies reported from 75.9 to 87.6% [26, 28]. This difference can largely be attributed to 2 possible reasons: first, the inclusion criteria bias, as the previous studies mainly included small HCCs (<3 cm); thus, a high proportion of HCCs especially for those <1 cm would be neglected because of the thickness.…”

Value of gadoxetic acid-enhanced MRI for microvascular invasion of small hepatocellular carcinoma: a retrospective study

“…Mosaic architecture refers to the difference present within mass of randomly distributed internal nodules or compartments differing in enhancement, attenuation, intensity, shape, and size and often separated by fibrous separations [ 18 ]. It is characteristic of a heterogeneous signal on T2WI [ 19 ]; (b) Intralesional fat: the chemical shift of intralesional fat cause an area shows significantly lower signal intensity (SI) on opposed–phase imagesT1WI compared with the SI in-phase images [ 20 ], which confirmed the presence of steatosis [ 21 ]; (c) intratumor hemorrhage: with ahyper–SI on unenhanced T1WI and a hypo–SI on T2WI [ 21 ]; (d) Iso/Hyperintense SI (T1WI):isointense (hyper–isointense) SI in the lesion on T1WI; (e) T2–weighted and diffusion-weighted imaging (T2–DW) mismatch: T2–DW mismatch mainly means a morphological mismatch, with a larger mass on thediffusion weighted imaging (DWI) images than T2WI images. Because of the image distortion on the DWI images, it was not accurate that only compare the lesion diameter or area on DWI with T2WI.…”

Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting

“…The ADC values for metastases show a significant overlap between ADC values of benign hepatocellular lesions and other malignant lesions [14]. Lesion characterization should therefore be done considering also morphological and functional data obtained by T2-W and T1-W sequences and dynamic studies [15,16]. Various liver-specific contrast media (cm) have been developed to improve the detection and characterization of hepatic lesions.…”