A New Diagnostic Criterion with Gadoxetic Acid-Enhanced MRI May Improve the Diagnostic Performance for Hepatocellular Carcinoma
Open Access
- 14 April 2020
- journal article
- research article
- Published by S. Karger AG in Liver Cancer
- Vol. 9 (4), 414-425
- https://doi.org/10.1159/000505696
Abstract
Background: To prospectively establish and validate new diagnostic criterion (DC) for liver-specific contrast agents and further compared the diagnostic sensitivity and specificity with conventional DC. Methods: Institutional Review Board approved and written informed consent were obtained for this prospective study. Two board-certified reviewers established the reference standard as hepatocellular carcinoma (HCC), non-HCC lesions by using marks on all cross-sectional MR images. Another 2 abdominal radiologists independently performed the marked lesion observations using 5 different DCs, including DC-1: arterial phase hyperenhancement (APHE) and portal venous phase washout; DC-2: APHE and hepatobiliary phase (HBP) hypointensity; DC-3: APHE and diffusion-weighted imaging (DWI) hyperintensity; DC-4: HBP hypointensity and DWI hyperintensity; DC-5: HBP hypointensity, DWI hyperintensity and excluded these markedly T2 hyperintensity. Diagnostic performance of sensitivity, specificity, and accuracy for each imaging DC was calculated, per-lesion diagnostic sensitivity and specificity of imaging criteria were compared by using McNemars test. Results: A total of 215 patients were included (mean age 53.82 ± 11.24 years; range 24–82 years) with 265 hepatic nodules (175 HCCs and 90 non-HCCs). The DC-4 (93.71%; 164/175) and DC-5 (92.57%; 162/175) yielded the highest diagnostic sensitivity and was better than DC-1 (72.57%; 127/175), DC-2 (82.86%; 145/175), and DC-3 (82.29%; 144/175) (all p < 0.001). The specificity of DC-1 (94.44%; 85/90) was significantly higher than that with DC-2 (83.33%; 75/90), DC-3 (84.44%; 76/90), DC-4 (74.44%; 67/90), and DC-5 (82.22%; 74/90) (all p < 0.05). Additionally, the DC-4 and DC-5 achieved the highest area under curve value of 0.841 (95% CI 0.783–0.899) and 0.874 (95% CI 0.822–0.925). Conclusions: The combined use of HBP hypointensity and DWI hyperintensity as a new DC for HCC enables a high diagnostic sensitivity and comparable specificity.Keywords
This publication has 29 references indexed in Scilit:
- World‐wide relative contribution of hepatitis B and C viruses in hepatocellular carcinomaJournal of Hepatology, 2015
- Hepatocellular Carcinoma: Diagnostic Performance of Multidetector CT and MR Imaging—A Systematic Review and Meta-AnalysisRadiology, 2015
- Liver Transplantation for Hepatocellular CarcinomaCurrent Gastroenterology Reports, 2015
- Sample size estimation in diagnostic test studies of biomedical informaticsJournal of Biomedical Informatics, 2014
- Hepatic haemangioma: Common and uncommon imaging featuresDiagnostic and Interventional Imaging, 2013
- Hepatocellular Carcinoma: Imaging Patterns on Gadoxetic Acid–enhanced MR Images and Their Value as an Imaging BiomarkerRadiology, 2013
- Which is the best MRI marker of malignancy for atypical cirrhotic nodules: Hypointensity in hepatobiliary phase alone or combined with other features? Classification after Gd‐EOB‐DTPA administrationJournal of Magnetic Resonance Imaging, 2012
- Imaging Study of Early Hepatocellular Carcinoma: Usefulness of Gadoxetic Acid–enhanced MR ImagingRadiology, 2011
- Intraindividual Comparison of Gadoxetate Disodium–enhanced MR Imaging and 64-Section Multidetector CT in the Detection of Hepatocellular Carcinoma in Patients with CirrhosisRadiology, 2010
- Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging.Radiology, 1995