Korean J Radiol.  2017 Jun;18(3):427-443. 10.3348/kjr.2017.18.3.427.

Diagnosis of Hepatocellular Carcinoma with Gadoxetic Acid-Enhanced MRI: 2016 Consensus Recommendations of the Korean Society of Abdominal Radiology

• Korean Society of Abdominal Radiology

• KMID: 2427298
• DOI: http://doi.org/10.3348/kjr.2017.18.3.427

Abstract

Diagnosis of hepatocellular carcinoma (HCC) with gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) poses certain unique challenges beyond the scope of current guidelines. The regional heterogeneity of HCC in demographic characteristics, prevalence, surveillance, and socioeconomic status necessitates different treatment approaches, leading to variations in survival outcomes. Considering the medical practices in Korea, the Korean Society of Abdominal Radiology (KSAR) study group for liver diseases has developed expert consensus recommendations for diagnosis of HCC by gadoxetic acid-enhanced MRI with updated perspectives, using a modified Delphi method. During the 39th Scientific Assembly and Annual Meeting of KSAR (2016), consensus was reached on 12 of 16 statements. These recommendations might serve to ensure a more standardized diagnosis of HCC by gadoxetic acid-enhanced MRI.

Keyword

Liver; Hepatocellular carcinoma; Magnetic resonance imaging; Gadoxetic acid; Consensus; Guidelines

MeSH Terms

Carcinoma, Hepatocellular/*diagnosis/diagnostic imaging/pathology
Contrast Media/*chemistry
Gadolinium DTPA/*chemistry
Humans
Liver Neoplasms/*diagnosis/diagnostic imaging/pathology
Magnetic Resonance Imaging
Radiography, Abdominal
Republic of Korea
Sensitivity and Specificity
Societies, Scientific
Tomography, X-Ray Computed
Contrast Media
Gadolinium DTPA

Figure

• 

  Fig. 1 HCC in 56-year-old man.A. Pre-contrast T1-weighted image shows hyperintense nodule (arrow) in segment VI of liver. B. In arterial-phase of gadoxetic acid-enhanced magnetic resonance imaging, nodule (arrow) exhibits hyperintensity relative to surrounding liver parenchyma. C. Subtraction image obtained by subtracting pre-contrast-enhanced and arterial-phase T1-weighted images depicts true arterial enhancement of nodule (arrow). HCC = hepatocellular carcinoma

• 

  Fig. 2 HCC in 82-year-old man with chronic hepatitis C.A-C. In gadoxetic acid-enhanced magnetic resonance images, 5-cm mass (arrows) exhibits arterial hyperenhancement (A), slight hyperintensity in portal venous phase (PVP) (B), and hypointensity in transitional phase (C). Washout appearance of nodule in PVP only might lead to false-negative diagnosis of HCC based on enhancement pattern. D. It (arrow) shows hypointensity on HBP. HBP = hepatobiliary phase, HCC = hepatocellular carcinoma

• 

  Fig. 3 Sub-centimeter-sized HCC in 56-year-old man with chronic hepatitis B.Gadoxetic acid-enhanced MR image demonstrates 0.8-cm nodule (arrows) in right lobe of liver, adjacent to portal vein (A). Nodule exhibits arterial hyperenhancement, persistent hyperintensity during portal venous phase (B), and hypointensity during transitional (C), and hepatobiliary phases (D). Lesion (arrows) also exhibits other ancillary features, including intermediate hyperintensity on T2-weighted images (E), and restricted diffusion (F). Lesion was pathologically confirmed as HCC after hepatic resection. HCC = hepatocellular carcinoma

• 

  Fig. 4 HCC with hepatobiliary phase (HBP) capsule appearance in 59-year-old female hepatitis B virus carrier.A. 2.8-cm tumor (arrow) in right posterior hepatic section shows hyperenhancement in arterial phase. B-D. Tumor (arrows) becomes hypointense relative to liver from portal phase (B), to late portal phase (C), and to transitional phase (3 minutes) (D), and shows no conventional capsule appearance (peripheral rim of smooth hyperenhancement). Note that smooth hypointense rim (arrow) begins to appear in transitional phase. E. In HBP, smooth hypointense rim (arrow) clearly surrounds tumor. F. Surgical specimen revealed well-capsulated tumor (cut in half), which was confirmed as HCC with complete fibrous capsule on microscopic examination. HCC = hepatocellular carcinoma

• 

  Fig. 5 Moderately differentiated HCC in 60-year-old man.2.1-cm-sized small hepatic nodule shows (arrows) isointensity during unenhanced T1-weighted image (A), arterial-phase (B), on portal venous and 3 minutes transitional-phase image (not shown) (C), and 20 minutes hepatobiliary-phase images after administration of gadoxetic acid (D). This lesion (arrows) is seen as hyperintense on single-shot echo-planar diffusion-weighed imaging at b = 800 sec/mm2 (E) and T2-weighted image (F). Surgical specimen revealed 2-cm, single nodular type HCC with Edmondson grade II (G). HCC = hepatocellular carcinoma

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