Hepatocellular Carcinoma in Patients with Chronic Liver Disease: Comparison of SPIO-enhanced MR Imaging and 16–Detector Row CT

Abstract

To compare the sensitivity, positive predictive value, and diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging with those of 16-detector row computed tomography (CT) for the detection of hepatocellular carcinoma (HCC) in patients with hepatitis B-induced cirrhosis. Institutional Review Board approval was obtained for this study, and informed consent was obtained from all patients. A total of 44 patients (36 men, eight women; age range, 35-67 years) with 59 HCCs and mild liver cirrhosis (Child-Pugh score A or B) underwent multiphasic CT and SPIO-enhanced MR imaging. The diagnosis of HCC was established at surgical resection (n = 31) and percutaneous biopsy (n = 28). SPIO-enhanced MR imaging was composed of T2-weighted turbo spin-echo and T2*-weighted gradient-echo sequences. Multiphasic CT consisted of four phases (ie, early arterial, late arterial, portal venous, and equilibrium). Three observers independently analyzed each image in random order. Sensitivity, positive predictive value, and diagnostic accuracy were calculated by using the alternative free-response receiver operating characteristic analysis for multi-detector row CT and SPIO-enhanced MR imaging. Although not significant (P > .05), the area under the receiver operating characteristic curve for SPIO-enhanced MR imaging (mean, 0.90) was higher than that for multi-detector row CT (mean, 0.82) for all observers. Also, although no significant difference was demonstrated by any of the three observers (P > .05), there was a trend toward increased sensitivity on both a per-lesion and a per-patient basis for SPIO-enhanced MR imaging (mean, 84.7% and 94.7%, respectively) compared with multi-detector row CT (mean, 76.9% and 88.6%, respectively). No significant difference in positive predictive value was observed between modalities. SPIO-enhanced MR imaging and multiphasic CT show similar diagnostic accuracy, sensitivity, and positive predictive value for the detection of HCC in patients with relatively mild hepatitis B-induced cirrhosis.