Diagnostic Performance of Gadoxetic Acid–enhanced Liver MR Imaging versus Multidetector CT in the Detection of Dysplastic Nodules and Early Hepatocellular Carcinoma

• Published in: Radiology Vol. 285; no. 1; pp. 134 - 146
• Main Authors: Kim, Bo Ram, Lee, Jeong Min, Lee, Dong Ho, Yoon, Jeong Hee, Hur, Bo Yun, Suh, Kyung Suk, Yi, Nam-Joon, Lee, Kyung Boon, Han, Joon Koo
• Format: Journal Article
• Language: English
• Published: United States 01.10.2017
• Subjects: Adult; Aged; Female; Gadolinium DTPA - therapeutic use; Humans; Liver - diagnostic imaging; Liver - pathology; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging - statistics & numerical data; Male; Middle Aged; Multidetector Computed Tomography - methods; Multidetector Computed Tomography - statistics & numerical data; Retrospective Studies; ROC Curve
• ISSN: 0033-8419; 1527-1315; 1527-1315
• DOI: 10.1148/radiol.2017162080

Purpose To compare the diagnostic performance of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging with that of contrast material-enhanced multidetector computed tomography (CT) in the detection of borderline hepatocellular nodules in patients with liver cirrhosis and to determine the Liver Imaging Reporting and Data System (LI-RADS) categories of these detected nodules. Materials and Methods The institutional review board approved this retrospective study and waived the informed consent requirement. Sixty-eight patients with pathologically proven dysplastic nodules (DNs) (low-grade DNs, n = 20; high-grade DNs, n = 17), early hepatocellular carcinomas (HCCs) (n = 42), or progressed HCCs (n = 33) underwent gadoxetic acid-enhanced MR imaging and multidetector CT. An additional 57 patients without any DNs or HCCs in the explanted livers were included as control subjects. Three radiologists independently graded the presence of liver nodules on a five-point confidence scale and assigned LI-RADS categories by using imaging findings. Jackknife alternative free-response receiver operating characteristics (JAFROC) software was used to compare the diagnostic accuracy of each modality in lesion detection. Results Reader-averaged figures of merit estimated with JAFROC software to detect hepatocellular nodules were 0.774 for multidetector CT and 0.842 for MR imaging (P = .002). Readers had significantly higher detection sensitivity for early HCCs with MR imaging than with multidetector CT (78.6% vs 52.4% [P = .001], 71.4% vs 50.0% [P = .011], and 73.8% vs 50.0% [P = .001], respectively). A high proportion of overall detected early HCCs at multidetector CT (59.4%) and MR imaging (72.3%) were categorized as LI-RADS category 4. Most early HCCs (76.2%) and high-grade DNs (82.4%) demonstrated hypointensity on hepatobiliary phase images. In total, 30 more LI-RADS category 4 early HCCs were identified with MR imaging than with multidetector CT across all readers. Conclusion Gadoxetic acid-enhanced MR imaging performed significantly better in the detection of high-risk borderline nodules, especially early HCCs, than did multidetector CT. RSNA, 2017 Online supplemental material is available for this article.