Abstract
Background: To prospectively establish and validate new DCs for liver-specific 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 HCC, non-HCC lesions by using marks on all cross-sectional MR images. Another two abdominal radiologists independently performed the marked lesion observations using five different diagnostic criterions, including DC-1: arterial phase hyperenhancement (APHE) and portal venous phase (PVP) 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 was compared by using McNemars test. Findings: A total of 173 patients were included (mean age, 53.82 ±11.04 years; range, 24-82 years) with 211hepatic nodules (145 HCCs and 66 non-HCCs). The DC-4 and DC-5 yielded the highest diagnostic sensitivity of 95.17% (138/145) and was better than DC-1 (69.66%, 101/145), DC-2 (80.69%, 117/145) and DC-3 (82.07%, 119/145) (all p<0.001). The specificity of DC-1 was significantly higher than that with DC-2 (78.79%, 52/66), DC-3 (80.30%, 53/66) and DC-4 (80.30%, 53/66) (all p<0.05), but no significant difference was obtained from DC-5 (84.85%, 56/66) (p=0.109). Interpretation: The combined use of HBP hypointensity and DWI hyperintensity as s new DC for HCC enables a high diagnostic sensitivity and comparable specificity. Funding: This work was supported by National Nature Science Foundation of China (Grant number 81771797), Science and Technology Support Program of Sichuan Province (Grant number 2017SZ0003). Declaration of Interest: The authors declare no potential conflicts of interests. Ethical Approval: Institutional review board approved and written informed consent were obtained for this prospective study.
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