Hepatocellular Carcinoma in Cirrhotic Liver: Double-Contrast-Enhanced, High-Resolution 3.0T-MR Imaging With Pathologic Correlation

Abstract

Objectives: To determine the diagnostic performance of double-contrast-enhanced (DCE) magnetic resonance imaging (MRI) at 3.0T in the detection of hepatocellular carcinoma (HCC) in patients with a cirrhotic liver. Materials and Methods: This study was approved by our Institutional Review Board and did not require informed consent. A total of 61 patients (52 men, 9 women; range 27–83 years) underwent DCE-MRI at 3.0T. DCE-MRI was composed of baseline MR images, superparamagnetic iron oxide-enhanced T2- and T2*-weighted images, and gadobenate-dimeglumine-enhanced dynamic MR images. The diagnosis of HCC was established at transplantation (n = 12) and hepatic resection (n = 49). Three observers independently analyzed each image in random order. The diagnostic performance, sensitivity, positive predictive value, numbers and causes of false positive and negative findings, and interobserver variability were calculated and analyzed on a per-lesion basis. Results: Sixty-one patients had 95 HCCs. From alternative free-response receiver operating characteristic analysis, averaged diagnostic performance (A_z) was 0.90. The mean sensitivity and positive predictive value of DCE-MRI at 3.0T for detection of HCCs were 89% and 97%, respectively. There was a significant difference in the sensitivity for the detection of HCCs between Child-Pugh class A and C patients (97% and 63%, respectively) (P < 0.01). In addition, the sensitivity according to lesion size was significantly different (P < 0.01). There were 7 false-positive lesions [arterio-portal shunt (n = 1), dysplastic nodule (n = 1), hemangioma (n = 2), and partial volume averaging (n = 3)]. Thirteen false-negatives occurred mainly because of small size (n = 4), partial uptake of superparamagnetic iron oxide (n = 6), faint arterial enhancement (n = 7), and location (n = 2). There was good interobserver variability (κ: 0.622–0.670). Conclusions: DCE 3.0T MR imaging is a highly sensitive modality for diagnosing HCCs in patients with a cirrhotic liver.