A retrospective analysis of the accuracy of T2-weighted images and dynamic gadolinium-enhanced sequences in the detection and characterization of focal hepatic lesions

Pawluk, Randolph S; Tummala, Satish; Brown, Jeffrey J.; Borrello, Joseph A.

doi:10.1002/(sici)1522-2586(199902)9:2<266::aid-jmri17>3.0.co;2-7

Cited by 23 publications

(11 citation statements)

References 29 publications

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“…[34,35] Chou et al [36] demonstrated that hyperintensity on T2WI was helpful in differentiating between dysplastic nodules and well-differentiated HCCs. On the other hand, Hussain et al [37] concluded that T2WI did not provide any additional diagnostic value in the detection and characterization of focal lesions in cirrhotic liver, because scar tissue in cirrhotic liver could occasionally mimic HCC on T2WI.…”

Section: Discussionmentioning

confidence: 99%

Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis

Shin

Kim²,

Choi³

et al. 2017

Medicine

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It is difficult to characterize the nodular lesions in cirrhotic liver if typical enhancement pattern is not present on dynamic contrast-enhanced imagings. Although the signal intensity of the hepatobiliary phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) is helpful for characterization of the lesions, some dysplastic nodules may also exhibit low signal intensity in the hepatobiliary phase. We aimed to assess the usefulness of gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI including diffusion-weighted imaging (DWI) for differentiation between atypical small hepatocellular carcinomas (HCCs) and dysplastic nodules showing low signal intensity (SI) in the hepatobiliary phase, and to evaluate the MRI findings in determining the histological grade of atypical HCCs in patients with cirrhosis.A total of 43 cirrhotic patients with a small (≤3 cm) liver nodule (n = 25, HCC; n = 18, dysplastic nodule) who underwent Gd-EOB-DTPA-enhanced MRI and pathologic confirmation were retrospectively reviewed. Atypical HCC was defined as not showing arterial hyperenhancement and delayed washout on dynamic MRI.High SI on both T2WI and DWI (sensitivity 80.0%, specificity 100%, positive predictive value 100%, negative predictive value 78.3%) was the most specific feature to differentiate atypical HCCs from dysplastic nodules. High SI on both T2WI and DWI (100% vs 61.5%, P = .039) or low SI on pre-enhanced T1WI (83.3% vs 30.8%, P = .021) was more frequent observed in Edmonson grade II–III HCCs compared with those in grade I HCCs.The combination of DWI and T2WI is most useful for the differentiation of atypical small HCCs from dysplastic nodules showing low SI in the hepatobiliary phase. Combination of DWI and T2WI or pre-enhanced T1WI seems to be useful for predicting the histological grade of atypical HCCs.

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Section: Discussionmentioning

confidence: 99%

Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis

Shin

Kim²,

Choi³

et al. 2017

Medicine

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“…This phenomenon may contribute to the high detection rate of small solid tumours on DWI [5,15]. Although the use of T 2 weighted images is helpful for the detection of the focal hepatic lesions [17,18], lesion detectability is suppressed by low lesion-to-liver contrast and the interfering high signal intensity from intrahepatic vessels [16]. Intrahepatic vessels may be seen as falsepositive lesions on T 2 weighted images.…”

Section: Dwi For Detection and Characterisation Of Hepatic Lesionsmentioning

confidence: 99%

The detection and discrimination of malignant and benign focal hepatic lesions:T₂weightedvsdiffusion-weighted MRI

Jahng¹,

Kim²,

Jin³

et al. 2011

BJR

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Objective: The purpose of this study was to evaluate the use of diffusion-weighted imaging (DWI) for the detection and characterisation of focal hepatic lesions compared with the use of T 2 weighted imaging. Method: 45 patients with 97 hepatic lesions (51 malignant lesions and 46 benign lesions) were included in this retrospective study. Malignant hepatic lesions included 12 hepatocellular carcinomas, 26 metastases and 13 intrahepatic cholangiocarcinomas. Benign hepatic lesions included 19 haemangiomas and 27 cysts. The MRI protocol for the upper abdomen included T 2 weighted images, in-and opposed-phase T 1 weighted images and dynamic T 1 weighted images. Breath-hold fat-suppressed single-shot echo planar DWI was performed with the following parameters: 1338/66; b factors, 0, 50 and 800 s mm -2 . Two independent observers reviewed the T 2 weighted images and the DWI to detect and to characterise the hepatic lesions. Results: For detection of malignant hepatic lesions, the use of DWI showed a significantly higher detection rate than the use of T 2 weighted images (p,0.05). However, there was no significant difference between the use of DWI and T 2 weighted images for benign hepatic lesions. For the differentiation between malignant and benign hepatic lesions, there was no significant difference in sensitivity, specificity and accuracy between the use of T 2 weighted images and the use of DWI. Conclusion: The use of DWI was better for the detection of malignant hepatic lesions than the use of T 2 weighted images. However, for detection of benign hepatic lesions and characterisation of hepatic lesions, the use of DWI was equivalent to the use of T 2 weighted images. Accurate detection and characterisation of focal hepatic lesions is important for treatment planning in patients with hepatic tumours. For the detection and characterisation of hepatic lesions, CT and MRI are usually employed [1,2]. MRI, T 1 weighted, T 2 weighted and gadoliniumenhanced T 1 weighted imaging have been commonly utilised [3,4].With rapid progress of the use of parallel imaging techniques such as sensitivity encoding (SENSE), the quality of diffusion weighted single-shot echo-planar imaging has improved [5]. Diffusion-weighted MRI of the abdomen has become possible by the use of this technique, which reduces acquisition time, minimises echo-planar imaging artefacts and improves the quality of images [5].Several studies have characterised focal hepatic lesions by measurement of the lesion apparent diffusion coefficient (ADC) [6][7][8][9][10][11] and have evaluated detection of focal hepatic lesion by use of diffusion-weighted imaging (DWI) [12][13][14][15][16]. However, there is still controversy regarding the value of DWI for the characterisation of focal hepatic lesions as the ADC values of different types of lesions overlap [6][7][8][9][10][11]. Furthermore, a limited number of studies have been performed using DWI for the detection of hepatic lesions [12][13][14][15][16].The purpose of this study was to evaluate the use of DWI for the d...

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“…Gadoxetic acidenhanced MRI . Therapeutic strategy Introduction techniques and the use of nonspecific, extracellular contrast agents [12,13]. This technique has shown to be almost equal to CT regarding detection of lesions, but differential diagnosis of tumors is improved due to the ability of dynamic MRI studies [14,45].…”

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confidence: 99%

Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions

et al. 2007

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A multicenter study has been employed to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). One hundred and sixty-nine patients with hepatic lesions eligible for surgery underwent Gd-EOB-DTPA-enhanced MRI as well as CT within 6 weeks. Pathologic evaluation of the liver specimen combined with intraoperative ultrasound established the SOR. Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: -4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT.

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A retrospective analysis of the accuracy of T2-weighted images and dynamic gadolinium-enhanced sequences in the detection and characterization of focal hepatic lesions

Cited by 23 publications

References 29 publications

Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis

Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis

The detection and discrimination of malignant and benign focal hepatic lesions:T₂weightedvsdiffusion-weighted MRI

Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions

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A retrospective analysis of the accuracy of T2-weighted images and dynamic gadolinium-enhanced sequences in the detection and characterization of focal hepatic lesions

Cited by 23 publications

References 29 publications

Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis

Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis

The detection and discrimination of malignant and benign focal hepatic lesions:T2weightedvsdiffusion-weighted MRI

Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions

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The detection and discrimination of malignant and benign focal hepatic lesions:T₂weightedvsdiffusion-weighted MRI