Abstract
ObjectivesTo compare 64-slice contrast-enhanced computed tomography (CT) with 3-Tesla magnetic resonance imaging (MRI) using Gd-EOB-DTPA for the diagnosis of hepatocellular carcinoma (HCC) and evaluate the utility of diffusion-weighted imaging (DWI) in this setting.Methods3-phase-liver-CT was performed in fifty patients (42 male, 8 female) with suspected or proven HCC. The patients were subjected to a 3-Tesla-MRI-examination with Gd-EOB-DTPA and diffusion weighted imaging (DWI) at b-values of 0, 50 and 400 s/mm2. The apparent diffusion coefficient (ADC)-value was determined for each lesion detected in DWI. The histopathological report after resection or biopsy of a lesion served as the gold standard, and a surrogate of follow-up or complementary imaging techniques in combination with clinical and paraclinical parameters was used in unresected lesions. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated for each technique.ResultsMRI detected slightly more lesions that were considered suspicious for HCC per patient compared to CT (2.7 versus 2.3, respectively). ADC-measurements in HCC showed notably heterogeneous values with a median of 1.2±0.5×10−3 mm2/s (range from 0.07±0.1 to 3.0±0.1×10−3 mm2/s). MRI showed similar diagnostic accuracy, sensitivity, and positive and negative predictive values compared to CT (AUC 0.837, sensitivity 92%, PPV 80% and NPV 90% for MRI vs. AUC 0.798, sensitivity 85%, PPV 79% and NPV 82% for CT; not significant). Specificity was 75% for both techniques.ConclusionsOur study did not show a statistically significant difference in detection in detection of HCC between MRI and CT. Gd-EOB-DTPA-enhanced MRI tended to detect more lesions per patient compared to contrast-enhanced CT; therefore, we would recommend this modality as the first-choice imaging method for the detection of HCC and therapeutic decisions. However, contrast-enhanced CT was not inferior in our study, so that it can be a useful image modality for follow-up examinations.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide
HCC can be diagnosed by various imaging modalities, including ultrasound, multidetector computed tomography (CT) and magnetic resonance imaging (MRI)
Patient Selection Fifty patients with suspected or proven HCC were included in this prospective single-centre study to evaluate the diagnostic performance of contrast-enhanced CT and Gd-EOB-DTPA-enhanced MRI in terms of lesion detection
Summary
Liver cirrhosis is a precancerous condition associated with the development of HCC. The sequential carcinogenesis from regenerative nodules to overt HCC has been described previously, and the de novo development of HCC without prior liver cirrhosis has been delineated [1,2,3,4,5]. HCC can be diagnosed by various imaging modalities, including ultrasound, multidetector computed tomography (CT) and magnetic resonance imaging (MRI). Despite these versatile imaging modalities, correct characterization of HCC versus other liver lesions remains a challenging task, and a definite diagnosis often cannot be made based on imaging alone [6]. In cancer patients, a precise diagnosis is important for optimal treatment planning [2,7]
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