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Jpn J Radiol. 2018 Aug;36(8):489-499. doi: 10.1007/s11604-018-0748-x. Epub 2018 Jun 6.

Differentiating malignant from benign hyperintense nodules on unenhanced T1-weighted images in patients with chronic liver disease: using gadoxetic acid-enhanced and diffusion-weighted MR imaging.

Author information

1
Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150 Seongan-ro Gangdong-Gu, Seoul, 134-701, South Korea.
2
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, 135-710, South Korea. kshyun@skku.edu.
3
Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Kyunggi-do, South Korea.
4
Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, South Korea.
5
Department of Radiology, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, South Korea.

Abstract

PURPOSE:

To evaluate value of gadoxetic acid-enhanced and diffusion-weighted (DW) MRI for distinguishing malignant from benign hyperintense nodules on unenhanced T1-weighted images (T1WIs) in patients with chronic liver disease.

MATERIALS AND METHODS:

Forty-two patients with 37 malignant and 41 benign hyperintense nodules on unenhanced T1WIs who underwent gadoxetic acid-enhanced and DW MRI, followed by histopathological examination, were included. Qualitative and quantitative analyses were conducted. Significant findings on univariate and multivariate analyses were identified and their diagnostic performances were analyzed for predicting hyperintense hepatocellular carcinomas (HCCs).

RESULTS:

In univariate analysis, hyperintensity on T2WI, arterial enhancement, washout, hypointensity on hepatobiliary phase, and diffusion restriction were more frequently observed (P < 0.05) in hyperintense HCCs. Tumor-to-liver SI ratio on hepatobiliary phase and minimum apparent diffusion coefficient (ADCmin) were significantly lower in hyperintense HCCs (P < 0.05). In multivariate analysis, hyperintensity on T2WI (OR, 13.58; P = 0.02), arterial enhancement (OR, 8.21; P = 0.002), and ADCmin ≤ 0.83 × 10-3 mm2/s (OR, 6.88; P = 0.008) were independently significant factors for predicting hyperintense HCCs. When two of three criteria were combined, 75.7% (28/37) of hyperintense HCCs were identified with a specificity of 92.7%, and when all three criteria were satisfied, the specificity was 97.6%.

CONCLUSION:

Gadoxetic acid-enhanced and DW MRI may be helpful for differentiating malignant from benign hyperintense nodules on unenhanced T1WI.

KEYWORDS:

Apparent diffusion coefficient; Diffusion magnetic resonance imaging; Hepatocellular carcinoma; Magnetic resonance imaging

PMID:
29876721
DOI:
10.1007/s11604-018-0748-x
[Indexed for MEDLINE]

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