Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤2 cm) HCC in cirrhosis

• Published in: European radiology 2011-06, Vol.21 (6), p.1233-1242
• Main Authors: Golfieri, Rita, Renzulli, Matteo, Lucidi, Vincenzo, Corcioni, Beniamino, Trevisani, Franco, Bolondi, Luigi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biopsy; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - pathology; Contrast agents; Contrast Media; Diagnostic Radiology; Female; Gadolinium DTPA; Hospitals; Humans; Imaging; Internal Medicine; Interventional Radiology; Liver cancer; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - pathology; Liver Neoplasms - complications; Liver Neoplasms - pathology; Magnetic Resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Neuroradiology; Radiology; Reproducibility of Results; Sensitivity and Specificity; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-010-2030-1

Objective To prospectively assess the additional value of the hepatobiliary (HB) phase of Gd-EOB-DTPA-MRI in identifying and characterising small (≤2 cm) hepatocellular carcinomas (HCCs) undetermined in dynamic phases alone because of their atypical features, according to the AASLD criteria. Methods 127 cirrhotic patients were evaluated with Gd-EOB-DTPA-MRI in two sets: unenhanced and dynamic phases; unenhanced, dynamic and HB phases. Sixty-two out of 215 nodules (29%) were atypical in 42 patients (33%). Results 62 atypical nodules were reported at histology: high-grade dysplastic nodules (HGDN)/early HCC ( n  = 20), low-grade DN (LGDN) ( n  = 21), regenerative nodules ( n  = 17) and nodular regenerative hyperplasia ( n  = 4). The sensitivity, specificity, accuracy, positive and negative predictive value (PPV, NPV) were increased by the addition of the HB phase: 88.4–99.4%, 88–95%, 88–98.5%, 97–99%, and 65–97.5%, respectively. Twenty atypical nodules were malignant (32%), 19 of which were characterised only during the HB phase. Conclusions The HB phase is 11% more sensitive in the classification of HGDN/early HCC than dynamic MRI, with an added value of 32.5% in the NPV. The high incidence (33%) of atypical nodules and their frequent malignancy (32%) suggest the widespread employment of Gd-EOB-DTPA-MRI in the follow-up of small nodules (≤2 cm) in cirrhosis.