Abstract
Purpose To compare the diagnostic performance of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging with that of contrast material-enhanced multidetector computed tomography (CT) in the detection of borderline hepatocellular nodules in patients with liver cirrhosis and to determine the Liver Imaging Reporting and Data System (LI-RADS) categories of these detected nodules. Materials and Methods The institutional review board approved this retrospective study and waived the informed consent requirement. Sixty-eight patients with pathologically proven dysplastic nodules (DNs) (low-grade DNs, n = 20; high-grade DNs, n = 17), early hepatocellular carcinomas (HCCs) (n = 42), or progressed HCCs (n = 33) underwent gadoxetic acid-enhanced MR imaging and multidetector CT. An additional 57 patients without any DNs or HCCs in the explanted livers were included as control subjects. Three radiologists independently graded the presence of liver nodules on a five-point confidence scale and assigned LI-RADS categories by using imaging findings. Jackknife alternative free-response receiver operating characteristics (JAFROC) software was used to compare the diagnostic accuracy of each modality in lesion detection. Results Reader-averaged figures of merit estimated with JAFROC software to detect hepatocellular nodules were 0.774 for multidetector CT and 0.842 for MR imaging (P = .002). Readers had significantly higher detection sensitivity for early HCCs with MR imaging than with multidetector CT (78.6% vs 52.4% [P = .001], 71.4% vs 50.0% [P = .011], and 73.8% vs 50.0% [P = .001], respectively). A high proportion of overall detected early HCCs at multidetector CT (59.4%) and MR imaging (72.3%) were categorized as LI-RADS category 4. Most early HCCs (76.2%) and high-grade DNs (82.4%) demonstrated hypointensity on hepatobiliary phase images. In total, 30 more LI-RADS category 4 early HCCs were identified with MR imaging than with multidetector CT across all readers. Conclusion Gadoxetic acid-enhanced MR imaging performed significantly better in the detection of high-risk borderline nodules, especially early HCCs, than did multidetector CT. © RSNA, 2017 Online supplemental material is available for this article.
Highlights
We found that all three readers showed significantly superior per-lesion sensitivity in detecting early hepatocellular carcinomas (HCCs) with gadoxetic acid–enhanced magnetic resonance (MR) imaging when compared with dynamic multidetector computed tomography (CT) (78.6% [33 of 42] vs 52.4% [22 of 42] for reader 1 [P = .001], 71.4% [30 of 42] vs 50.0% [21 of 42] for reader 2 [P = .011], and 73.8% [31 of 42] vs 50.0% [21 of 42] for reader 3 [P = .001]) (Fig 2)
When we further subclassified hepatocellular nodules into low-grade dysplastic nodules (DNs), high-grade DNs, early HCCs, and progressed HCCs, our study showed that all three readers had significantly higher sensitivity in detecting early HCCs with gadoxetic acid–enhanced MR imaging than with multidetector CT
Studies have shown that the presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules that were presumably either DNs or early HCCs was a significant risk factor for the recurrence of hypervascular HCCs during follow-up after hepatectomy and radiofrequency ablation [30,31]
Summary
The primary aim of this study is to compare the diagnostic performance of gadoxetic acid–enhanced MR imaging and contrast-enhanced liver multidetector CT in the detection of high-risk borderline nodules, including high-grade DNs and early HCCs, in patients with liver cirrhosis, with a secondary aim to determine the Liver Imaging Reporting and Data System (LI-RADS) categories of these detected nodules
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