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J Hepatol. 2019 May 17. pii: S0168-8278(19)30286-7. doi: 10.1016/j.jhep.2019.05.005. [Epub ahead of print]

Arterial Subtraction Images of Gadoxetate-Enhanced MRI Improve Diagnosis of Early-Stage Hepatocellular Carcinoma.

Author information

1
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Republic of Korea.
2
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Republic of Korea. Electronic address: jhbyun@amc.seoul.kr.
3
Department of Gastroenterology, Liver Center, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Republic of Korea.

Abstract

BACKGROUND & AIMS:

Although gadoxetate disodium-enhanced magnetic resonance imaging (MRI) shows higher sensitivity for diagnosing hepatocellular carcinoma (HCC), its arterial-phase images may be unsatisfactory because of weak arterial enhancement. We investigated the clinical effectiveness of arterial subtraction images from gadoxetate disodium-enhanced MRI for diagnosing early-stage HCC using the Liver Imaging Reporting and Data System (LI-RADS) v2018.

METHODS:

A total of 372 hepatic nodules (273 HCCs, 18 other malignancies, and 81 benign nodules) of 3.0 cm or smaller from 258 patients at risk of HCC who underwent gadoxetate disodium-enhanced MRI in 2016 were retrospectively analyzed. Final diagnosis was assessed histopathologically or clinically (marginal recurrence after treatment or change in lesion size on follow-up imaging). The detection rate for arterial hyperenhancement was compared between ordinary arterial-phase and arterial subtraction images, and the benefit of arterial subtraction images in diagnosing HCC using LI-RADS was assessed.

RESULTS:

Arterial subtraction images had a significantly higher detection rate for arterial hyperenhancement than ordinary arterial-phase images, both for all hepatic nodules (72.3% vs. 62.4%, p<.001) and HCCs (91.9% vs. 80.6%, p<.001). Compared with ordinary arterial-phase images, arterial subtraction images significantly increased the sensitivity of LI-RADS category 5 for diagnosis of HCC (64.1% [173/270] vs. 55.9% [151/270], p<.001), without significantly decreasing specificity (92.9% [91/98] vs. 94.9% [93/98], p=.155). For histopathologically confirmed lesions, arterial subtraction images significantly increased sensitivity to 68.8% (128/186) from the 61.3% (114/186) of ordinary arterial-phase images (p<.001), with a minimal decrease in specificity to 84.8% (39/46) from 89.1% (41/46) (p=.151).

CONCLUSIONS:

Arterial subtraction images of gadoxetate disodium-enhanced MRI can significantly improve the sensitivity for diagnosing early-stage HCC, without a significant decrease in specificity, using LI-RADS.

LAY SUMMARY:

When applied to the LI-RADS on gadoxetate disodium-enhanced MRI, the arterial subtraction images are clinically useful to improve diagnosis of early-stage HCC.

KEYWORDS:

Diagnosis; Gadoxetate disodium; Hepatocellular carcinoma; Magnetic resonance imaging; Subtraction technique

PMID:
31108157
DOI:
10.1016/j.jhep.2019.05.005

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