Korean J Radiol.  2020 Mar;21(3):280-289. 10.3348/kjr.2019.0447.

Characterizing Computed Tomography-Detected Arterial Hyperenhancing-Only Lesions in Patients at Risk of Hepatocellular Carcinoma: Can Non-Contrast Magnetic Resonance Imaging Be Used for Sequential Imaging?

• Park SH
• Kim B
• Kim SY
• Choi SJ
• Huh J
• Kim HJ
• Kim KW
• Lee SS

• KMID: 2470751
• DOI: http://doi.org/10.3348/kjr.2019.0447

Abstract

OBJECTIVE
To test the feasibility of non-contrast magnetic resonance imaging (MRI) in a sequential imaging study for characterizing computed tomography (CT)-detected arterial-enhancing nodules that do not washout in patients at risk of hepatocellular carcinoma (HCC).
MATERIALS AND METHODS
In this retrospective study, 134 patients (mean age ± standard deviation, 56.8 ± 10.0 years) with 151 arterial enhancing-only nodules measuring up to 2 cm during multiphasic CT that were subsequently evaluated using gadoxetic acid-enhanced MRI in treatment-naïve at-risk patients from three tertiary referral centers were included. Tentative diagnostic criteria for HCC and hepatic malignancy were defined as the presence of one of eight MRI features favoring HCC in combinations of the following sequences: T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), T1-weighted dual gradient-echo in-phase and out-of-phase imaging (Dual-GRE), and hepatobiliary phase imaging (HBP). Typical hemangiomas and arterioportal shunts were excluded from the analysis. Diagnostic performance for HCC and hepatic malignancy was calculated and compared between the abbreviated MRI and full-sequence gadoxetic acid-enhanced MRI.
RESULTS
Of 151 nodules (mean size, 1.2 cm) 68 HCCs and 83 non-HCC benignities and malignancies were included. The combination of T2WI, DWI, and Dual-GRE showed per-lesion sensitivity, specificity, and accuracy of 88.2%, 90.4%, and 89.4%, respectively, comparable to those of full-sequence MRI. Applying the same sequence combination to diagnose hepatic malignancy had per-lesion sensitivity, specificity, and accuracy of 86.8%, 97.3%, and 92.1%. In nodules < 1 cm, adding HBP increased sensitivity by up to 13% without compromising the specificity or accuracy.
CONCLUSION
The non-contrast MRI protocol comprising T2WI, DWI, and Dual-GRE showed reasonable and comparable performance to full-sequence MRI for discriminating HCC and primary liver malignancies in CT-detected indeterminate arterial enhancing-only nodules in at-risk patients, and can be potentially used for sequential imaging in place of a full-sequence MRI. In nodules < 1 cm, HBP may still be needed to preserve sensitivity.

Keyword

Hepatocellular carcinoma; Liver; Magnetic resonance imaging; Noncontrast MRI

MeSH Terms

Carcinoma, Hepatocellular*
Hemangioma
Humans
Liver
Magnetic Resonance Imaging*
Retrospective Studies
Sensitivity and Specificity
Tertiary Care Centers

Figure

• 

  Fig. 1 Patient flow diagram. AP = arterioportal, CT = computed tomography, HCC = hepatocellular carcinoma, MRI = magnetic resonance imaging

• 

  Fig. 2 HCC in 55-year-old man with chronic hepatitis B. Multiphasic CT revealed 1.8-cm arterial enhancing nodule (arrowhead) in segment 8 of liver (A), with no washout in portal venous phase (B) or in 3-minute delayed phase (C). On T2-weighted image, nodule (arrowhead) shows mildly high signal intensity (D), with diffusion restrictions (arrowheads) (E, F) (b = 800 s/mm2) and without any fat component on T1-weighted dual gradient-echo images (G, H). This nodule was correctly diagnosed as HCC by combining non-contrast MRI.

• 

  Fig. 3 Arterioportal shunt in 48-year-old man with chronic hepatitis B. Multiphasic CT revealed 1.9-cm arterial enhancing nodule in segment 8 of liver (arrowhead) (A, B), with no washout in portal venous phase (C) or in 3-minute delayed phase (D). There is no high signal intensity in matching area on T2-weighted image (E), no diffusion restriction (F, G) (b = 800 s/mm2), and no fat component on T1-weighted dual gradient-echo images (H, I). The nodule was correctly diagnosed as non-HCC by combining non-contrast MRI.

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