J Korean Soc Radiol.  2018 Dec;79(6):340-347. 10.3348/jksr.2018.79.6.340.

Value of Image Subtraction for the Identification of Hepatocellular Carcinoma Capsule on Gadoxetic Acid-Enhanced MRI

• Kim H
• Ahn JH
• Moon JS
• Cha SW

• KMID: 2427383
• DOI: http://doi.org/10.3348/jksr.2018.79.6.340

Abstract

PURPOSE
To evaluate value of image subtraction for identifying hepatocellular carcinoma (HCC) capsule on gadoxetic acid-enhanced MR images.
MATERIALS AND METHODS
This study involved 108 patients at risk of HCC preoperatively examined using gadoxetic acid-enhanced MRI with hepatic resection between May 2015 and February 2017. We evaluated qualities of subtraction images and presence of capsular appearance on portal venous or transitional phases conventional and subtraction images. We assessed effect of capsular appearance on subtraction images on HCC.
RESULTS
After excluding 1 patient who had treated by transarterial chemoembolization prior to surgery and 33 patients with unsatisfactory subtraction image qualities, 82 focal hepatic lesions (73 HCC, 5 non-HCC malignancies, and 4 benign) from 74 patients were analyzed. Regarding detection of capsules, sensitivity, accuracy, and area under the receiver operating characteristic curve (AUC) on subtraction images were significantly higher than those on conventional images (95.4%, 89.0%, and 0.80, respectively; p < 0.001), though specificities were same (64.7%). For diagnosis of HCC, sensitivity, accuracy, and AUC on subtraction images were significantly higher than on conventional images (82.2%, 79.3%, and 0.69, respectively; p = 0.011), though specificities were identical (55.6%).
CONCLUSION
Portal venous or transitional phase gadoxetic acid-enhanced MRI subtraction images could improve detection of HCC capsule.

MeSH Terms

Area Under Curve
Capsules
Carcinoma, Hepatocellular*
Diagnosis
Humans
Magnetic Resonance Imaging*
ROC Curve
Subtraction Technique
Capsules

Figure

• 

  Fig. 1 Case of a 73-year-old woman with hepatocellular carcinoma encased by a histopathologically confirmed fibrous capsule in the right liver A. A conventional capsular appearance is not well visualized in the conventional TP image. B. However, a smooth hyperintense rim is readily detected on the subtracted TP image. TP = transitional phase

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