Optimal Combination of Features on Gadoxetate Disodium-enhanced MR Imaging for Non-invasive Differential Diagnosis of Hepatocellular Carcinoma: The JAMP-HCC Study

Abstract

Purpose:To determine the optimal combination of gadoxetate disodium-enhanced magnetic resonance imaging (MRI) findings for the diagnosis of hepatocellular carcinoma (HCC) and to compare its diagnostic ability to that of dynamic computed tomography (CT) in patients with chronic liver disease. Methods:This multi-institutional study consisted of two parts: Study 1, a retrospective study to determine the optimal combination of gadoxetate disodium-enhanced MRI findings (decision tree and logistic model) to distinguish HCC (n = 199) from benign (n = 81) or other malignant lesions (n = 95) (375 nodules in 269 patients) and Study 2, a prospective study to compare the diagnostic ability of gadoxetate disodiumenhanced MRI to distinguish HCC (n = 73) from benign (n = 15) or other malignant lesions (n = 12) with that of dynamic CT (100 nodules in 83 patients). Two radiologists independently evaluated the imaging findings (Study 1 and 2) and made a practical diagnosis (Study 2). Results:In Study 1, rim or whole enhancement on arterial phase images, signal intensities on T 2 -weighted/ diffusion-weighted/portal venous/transitional/hepatobiliary phase images, and signal drop on opposedphase images were independently useful for differential diagnosis. In Study 2, the accuracy, sensitivity, negative predictive value, and negative likelihood ratio of the CT decision tree (reader 2) were higher than those of MRI Model 2 (P = 0.015-0.033). There were no other significant differences in diagnostic ability (P = 0.059-1.000) and radiologist-made practical diagnosis (P = 0.059-1.000) between gadoxetate disodiumenhanced MRI and CT. Conclusion:We identified the optimal combination of gadoxetate disodium-enhanced MRI findings for HCC diagnosis. However, its diagnostic ability was not superior to that of dynamic CT.

Clinical Significance of Liver MR Imaging

“…Currently, gadoxetic acid is used almost exclusively for liver MRI examinations in daily clinical practice in Japan because of its high performance in lesion detection and characterization. 4,[16][17][18] Traditionally, sensitivity is important in Japan because the Japan Society of Hepatology (JSH) guideline recommends liver resection or locoregional therapy based on early detection of HCC. 19 However, in the United States and Europe, liver transplantation is an important treatment option; thus, specificity is important.…”

An Intra-individual Comparison between Free-breathing Dynamic MR Imaging of the Liver Using Stack-of-stars Acquisition and the Breath-holding Method Using Cartesian Sampling or View-sharing

“…Gadoxetate disodium is a liver-specific contrast agent that is widely used in liver MRI because of its high performance in lesion detection and characterization. [1][2][3][4][5] However, several studies have reported that transient respiratory motion artifacts or truncation artifacts in the arterial phase (AP) can be observed more frequently in dynamic contrast-enhanced MRI (DCE-MRI) with gadoxetate disodium than that with extracellular contrast agents, [6][7][8] resulting in nondiagnostic image quality in the AP. DCE-MRI of the liver is typically performed using a breath-holding 3D gradient echo sequence (e.g., liver acquisition with volume acceleration, LAVA) with > 15 s of breathholding.…”

Distinction Between Hepatocellular Carcinoma and Hypervascular Liver Metastases in Non-cirrhotic Patients Using Gadoxetate Disodium-Enhanced Magnetic Resonance Imaging

“…In recent years, gadoxetate disodium has become widely used for liver MRI in daily clinical practice because of its high performance in lesion detection and characterization. [18][19][20] However, few studies have discussed the imaging features of HLM on MRI. 10,[21][22][23] Our aim was to assess that gadoxetate disodium-enhanced MRI can be useful for distinguishing HCC from HLM because of this modality's multiparametric techniques, including chemical shift imaging, T2-weighted images (T2WI), DWI, dynamic study, and HBP.…”