J Korean Soc Radiol.  2013 Sep;69(3):213-222. 10.3348/jksr.2013.69.3.213.

Detection of Hepatocellular Carcinoma: Comparison of Gadoxetic Acid-Enhanced MRI, Diffusion-Weighted Imaging, and Combined Interpretation at 3 T MRI

• Park SH
• Chung YE
• Hong HS
• Kim KW
• Kim MJ
• Choi JY

• KMID: 2208804
• DOI: http://doi.org/10.3348/jksr.2013.69.3.213

Abstract

PURPOSE
To compare diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced (Gdx) magnetic resonance imaging (MRI), whether alone or in combination, for the detection of hepatocellular carcinoma (HCC) by using 3 T.
MATERIALS AND METHODS
84 HCCs in 66 patients (57 men, 9 women; mean age 69.2 years) were examined using 3 T MRI. DWI (b values 0, 50, and 800 sec/mm2) and dynamic gadoxetic acid-enhanced MRI as well as hepatobiliary phase were performed. Images were retrospectively reviewed by two radiologists to compare the diagnostic performances of DWI and Gdx MRI alone and in combination for the detection of HCC. Alternative free response receiver operating characteristic analysis and comparison of sensitivities were used for statistical analysis.
RESULTS
The sensitivity of Gdx set (73/84, 87%) was significantly higher than that of DWI set (60.5/84, 72%) for both observers. The Az values of DWI and Gdx MRI for the detection of HCC were not statistically significant for either observer (Az for DWI = 0.818 and 0.864, Az for Gdx MR = 0.902 and 0.842, respectively, p = 0.107 for observer 1 and p = 0.738 for observer 2). The combination of both techniques did not increase the sensitivities of detecting HCC in either observer. When lesions smaller than 2 cm were considered, the DWI set yielded a significantly lower sensitivity as compared with either the Gdx set alone or the combination set.
CONCLUSION
Gadoxetic acid-enhanced MRI was better than DWI for detection the HCC by using 3 T MRI. The combination of DWI and Gdx MRI did not contribute to the successful detection of HCC.

MeSH Terms

Carcinoma, Hepatocellular
Humans
Magnetic Resonance Imaging
Male
Retrospective Studies
ROC Curve

Figure

• 

  Fig. 1 Two hepatocellular carcinomas in a 48-year-old man. A. Gadoxetic acid-enhanced MRI image during the arterial phase shows two enhancing masses, one in the right hepatic lobe (black arrow) and one in segment 4 (white arrow). B. A hepatobiliary phase image 20 minutes after contrast administration shows hypointense masses at the same locations (black and white arrows). C. Diffusion-weighted image (DWI) demonstrates a hyperintense lesion (arrow) at S4. However, the lesion in the right hepatic lobe is not depicted on DWI. D. Follow-up unenhanced CT one month after transarterial chemoembolization shows iodized oil retention in S4 and the right lobe.

• 

  Fig. 2 Hepatocellular carcinoma in a 42-year-old man. The main mass, 4 cm sized expansile hypervascular tumor at S6, is not shown here. A, B. Gadoxetic acid-enhanced MR image during arterial phase (A) and hepatobiliary phase (B) show a satellite nodule in the right hepatic lobe (arrows). C. The lesions are not visible on DWI using b values of 50 s/mm2. D. Photograph of the surgical specimen shows a main mass and a small hepatocellular carcinoma (arrow). Note.-DWI = diffusion-weighted imaging

• 

  Fig. 3 Hepatocellular carcinoma in a 45-year-old man. A. Gadoxetic acid-enhanced MR images during the arterial phase show two enhancing nodules in the left hepatic lobe (black and white arrows). B. The lesions show hypointensity on hepatobiliary phase images at the same location (black and white arrows). C. Only the lesion at S3 is visible on DWI using b values of 800 s/mm2 (arrow). D. Follow-up CT shows compact iodized oil retention at S3. The lesion at S4 did not show any enhancement or washout during the follow-up period of one and a half years. Note.-DWI = diffusion-weighted imaging

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