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J Magn Reson Imaging. 2017 Jun;45(6):1599-1608. doi: 10.1002/jmri.25493. Epub 2016 Oct 11.

Washout appearance in Gd-EOB-DTPA-enhanced MR imaging: A differentiating feature between hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase and focal nodular hyperplasia-like nodules.

Author information

1
Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
2
Korea University College of Medicine, Seoul, South Korea.

Abstract

PURPOSE:

To identify the most reliable imaging features for differentiating hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase (HCCpara ) from focal nodular hyperplasia (FNH)-like nodules using Gd-EOB-DTPA-enhanced MRI.

MATERIALS AND METHODS:

This was a retrospective study. Twenty patients with HCCpara and 21 patients with FNH-like nodules were included. The following MRI features were evaluated using 3.0 Tesla unit by two radiologists: signal intensity (SI) on T1-, T2-, and diffusion-weighted imaging (DWI), arterial enhancement pattern, washout appearance on the portal venous phase (PVP) and/or transitional phase (TP), uptake pattern on the hepatobiliary phase (HBP), "T2 scar," "EOB scar," and chemical shift on in- and out-of-phase images. Multivariate logistic regression analysis was performed to assess MRI features for prediction of HCCpara .

RESULTS:

Compared with FNH-like nodules, HCCpara had significantly more frequent heterogeneous T1 SI (P < 0.0001), T2 hyperintensity (P = 0.032), heterogeneous arterial enhancement (P < 0.0001), washout appearance on the PVP and/or TP (P < 0.0001), heterogeneous uptake on the HBP (P < 0.0001), absence of "EOB scar" (P < 0.0001), and hyperintensity on DWI (P = 0.004). Multivariate logistic regression analysis revealed washout appearance as the only independent imaging feature associated with HCCpara (odds ratio, 7.019; P = 0.042). Washout appearance also showed the best diagnostic performance with a sensitivity of 90% and a specificity of 100%.

CONCLUSION:

Washout appearance on the PVP and/or TP is the most reliable imaging feature for differentiating HCCpara from FNH-like nodules.

LEVEL OF EVIDENCE:

3 J. MAGN. RESON. IMAGING 2017;45:1599-1608.

KEYWORDS:

FNH like nodule; gadoxetic acid; hepatocellular carcinoma; magnetic resonance imaging; washout

PMID:
27726242
DOI:
10.1002/jmri.25493
[Indexed for MEDLINE]

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