CT versus MR Imaging of Hepatocellular Carcinoma: Toward Improved Treatment Decisions

Abstract

Detection, characterization, staging, and treatment monitoring are major roles of diagnostic imaging of liver cancers. Developments in multidetector-row computed tomography (MDCT) technology have increased the spatial and temporal resolution of CT to allow more precise evaluation of the hemodynamics of liver tumors and improve the diagnostic accuracy of dynamic MDCT. The high spatial and temporal resolutions of dynamic MDCT enable us to reconstruct 3-dimensional (3D) images that are very useful for pretreatment evaluation. Dynamic MR imaging with fast 3D T 1 -weighted gradient echo imaging sequence using nonspeciˆc contrast medium can be highly sensitive for detecting hypervascular HCC. However, the use of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), a contrast medium speciˆc to hepatic tissue, oŠers greater diagnostic ability and, so, has become essential to liver imaging. MR imaging with Gd-EOB-DTPA may replace CT during hepatic arteriography and CT during arterioportography.

Characterization of hepatocellular carcinoma (HCC) lesions using a novel CT-based volume perfusion (VPCT) technique

“…However, perfusionbased HCC-characteristics are not always present in early HCC and differentiation from dysplastic nodules and even regenerative nodules can be challenging [5,8]. Different other imaging techniques, in particular MRI using sequence-dependent signal characteristics, dynamic contrast agent studies and hepatospecific contrast agents have been therefore recommended for a more confident diagnostic [9][10][11]. Admitting that increasing arterialization is a characteristic of HCC, non-invasive quantification of the tumor arterial supply could represent surrogate information expected to deliver essential information even in less well A c c e p t e d M a n u s c r i p t tissue generating time density curves (TDC) [12,13].…”

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

“…64,65 Several studies have shown that gadoxetic acid-enhanced MR imaging is useful in diagnosing conventional HCCs and, in fact, may sometimes be more reliable than dynamic contrast-enhanced 16-to 64-slice multidetector-row CT for this purpose. 9,36,66,67 When using an extracellular GBCA, sensitivity and specicity of MR imaging are excellent even for small HCCs. 68 However, some researchers suggest that the hepatocyte phase of gadoxetic acid might have added value to detect more HCCs than dynamic phases especially for less-experienced observers.…”

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

“…It has actually become common to encounter cases where hypervascular HCC or nodule-in-nodule HCC that is undetectable by MDCT is detected in a routine screening by EOB-MRI because of early enhancement in the arterial phase or clear hypointensity in the hepatobiliary phase [11,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103]. Furthermore, studies comparing the diagnostic performance of EOB-MRI and MDCT for hypervascular HCC have shown that EOB-MRI is superior or, at the very l...…”