Non-contrast Magnetic Resonance Imaging versus the Multiphase Computed Tomography with Respect to the Asia-Pacific Clinical Practice Guidelines: A Diagnostic Performance Study for Liver Cancer.

Abstract

Guidelines recommend multiphasic computed tomography (CT) and/or contrast-enhanced magnetic resonance imaging (MRI) for the detection of hepatocellular carcinoma. The objectives of the study were to compare diagnostic parameters of non-contrast MRI against multiphase CT for diagnostic of hepatocellular carcinoma in patients who at risk of liver cancer considering Asia-Pacific clinical practice guidelines as the reference standard. Medical records of patients with chronic hepatic disease or have suspected liver cancer in surveillance of fewer than 100 days and underwent multiphasic CT, gadoxetic acid-enhanced MRI, and liver biopsy for diagnosis of liver cancer were included in analysis. Enhancement during the arterial phase and wash-out during a delayed phase or portal-venous considered as hepatocellular carcinoma in the multiphase CT. Mild-to-moderate hypersensitivity in imaging, presence of fat on out-of-phase imaging, non-enhancing capsule(s), mosaic appearance, hemorrhagic content, and/or nodule-in-nodule considered as hepatocellular carcinoma in MRI. Asia- Pacific clinical practice guidelines considered for biopsy/histopathology for detection of hepatocellular carcinoma. For detection of hepatocellular carcinoma, non-contrast MRI had higher sensitivity (0.843 vs. 0.762, P < .001, q = 3.919) and accuracy (0.755 vs. 0.571, P < .001, q = 3.362) than the multiphase CT. While specificity was the same (0.864 vs. 0.809, P < .001, q = 2.584). Non-contrast MRI had 0-0.91 diagnostic confidence and multiphase CT had 0.49-0.81 diagnostic confidence for the detection of hepatocellular carcinoma. Non-contrast MRI easily facilitates the decision of chemotherapy and/or radiotherapy than multiphase CT in hepatocellular carcinoma.