J Korean Soc Radiol.  2013 Apr;68(4):319-328. 10.3348/jksr.2013.68.4.319.

The Proper Scan Delay of the Hepatobiliary Phase of Gadoxetic Acid-Enhanced Magnetic Resonance Imaging to Evaluate Small-Sized (< or = 3 cm) Hepatocellular Carcinoma in Cirrhotic Liver

• Lee JH
• Jeong YY
• Heo SH
• Shin SS
• Kim JW
• Kang HK

• KMID: 1425148
• DOI: http://doi.org/10.3348/jksr.2013.68.4.319

Abstract

PURPOSE
To assess the optimal scan delay of hepatobiliary phase of gadoxetic acid (GA)-enhanced magnetic resonance (MR) imaging for small-sized (< or = 3 cm) hepatocellular carcinomas (HCCs) in cirrhotic liver.
MATERIALS AND METHODS
There were 71 HCCs included in this study, derived from 53 patients with liver cirrhosis. Hepatobiliary phase MR imaging was obtained at 10, 15 and 20 mins after GA injection. For quantitative analysis, 2 radiologists calculated signal to noise ratio (SNR), enhancement ratio (ER) of the tumor and liver parenchyma and contrast-to-noise ratio (CNR) at 10 min, 15 min, and 20 min images, respectively. For qualitative analysis, 3 radiologists independently reviewed the 3 different phase about HCC possibilities using a 5-point scale. For each observer, the diagnostic accuracy of different hepatobiliary phases was compared using the area under the alternative free-response receiver operating characteristic curve (Az). In addition, sensitivity and specificity were compared.
RESULTS
No significant differences in SNR, ER and CNR at 10 min, 15 min, and 20 min were found. The Az values for HCC possibility were not significantly different. Sensitivity and specificity were also not significantly different.
CONCLUSION
Hepatobiliary phase MR imaging were obtained at 10 min, 15 min and 20 min yield comparable diagnostic information, so that the choice of scan delay can be adapted according to the clinical routine needs.

MeSH Terms

Carcinoma, Hepatocellular
Gadolinium DTPA
Humans
Liver
Liver Cirrhosis
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
ROC Curve
Sensitivity and Specificity
Signal-To-Noise Ratio
Gadolinium DTPA

Figure

• 

  Fig. 1 Signal-to-noise ratios (SNRs) (A), enhancement ratio (ERs) of the tumor (B) and liver parenchyma (C) and contrast-to-noise ratios (CNRs) (D). There are no significant differences in CNR at 10, 15 and 20 minutes imaging after contrast administration.

• 

  Fig. 2 MR images in 69-year-old man with HCC (arrow) in liver segment VII. Preenhanced image (A), gadoxetic acid-enhanced T1WIs obtained 30 s (B), 180 s (C), 10 minutes (D), 15 minutes (E) and 20 minutes (F) after contrast injection show a 2.1 cm HCC. HCC possibility by all three observers is 5 in the images obtained 10, 15 and 20 minutes after contrast injection. This HCC is confirmed by typical imaging finding on liver MRI (enhancement on arterial phase and washout on portal or delayed phase images). Note.-HCC = hepatocellular carcinoma, T1WI = T1 weighted image

• 

  Fig. 3 MR images in 57-year-old man with HCC (arrow) in liver segment IV. Preenhanced image (A), gadoxetic acid-enhanced T1WIs obtained 30 s (B), 180 s (C), 10 minutes (D), 15 minutes (E) and 20 minutes (F) after contrast injection show a 1 cm HCC. This HCC is overlooked by all three observers because of multiple cirrhotic nodules of variable sizes. This HCC is confirmed by typical imaging finding on liver MRI (enhancement on arterial phase and washout on portal or delayed phase images). Note.-HCC = hepatocellular carcinomas, T1WI = T1 weighted image

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