Performance of Gd‑EOB‑DTPA‑enhanced MRI for the diagnosis of LI‑RADS 4 category hepatocellular carcinoma nodules with different diameters

Abstract

In 2011, the American College of Radiology released a standardized reporting and data collection system, named Liver Imaging Reporting and Data System (LI-RADS), to improve the consistency of diagnostic imaging examinations of hepatocellular carcinoma (HCC). When the LI-RADS guideline was updated in 2014, hepatobiliary contrast agents, including gadoxetate acid (Gd-EOB-DTPA), were incorporated into the system. However, the diagnostic performance of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for nodules of different diameters has not been addressed. In the present study, a total of 263 LI-RADS 4 category hepatic nodules were examined blindly and independently by two radiologists. All nodules were divided into two datasets: Set 1 (n=86) that included nodules with iso/hypo-intensity in the arterial phase (HCC, n=42; non-HCC, n=44) and set 2 (n=177) that included nodules with hyper-intensity in the arterial phase (HCC, n=131; non-HCC, n=46). The diagnostic performance of Gd-EOB-DTPA-enhanced MRI for evaluation of nodules with different diameters was evaluated. The present study revealed that the diagnostic performance of Gd-EOB-enhanced MRI of larger nodules (>2 cm) was higher compared with (<2 cm) smaller nodules. The FPR of large nodules (>2 cm) with a hypervascular pattern was lower compared with smaller nodules (<2 cm) with hypovascular pattern. In conclusion, Gd-EOB-enhanced MRI is useful for the diagnosis of HCC where hypervascular LI-RADS 4 nodules are >2 cm in diameter. However, Gd-EOB-enhanced MRI may be of limited use for the assessment of nodules that <20 mm due to low diagnostic performance and high FPR.

Bi-specific T1 positive-contrast-enhanced magnetic resonance imaging molecular probe for hepatocellular carcinoma in an orthotopic mouse model

“…The success of OATP-based agents is highly dependent upon liver function and might lead to confusion for other diseases also exhibiting low-level OATP expression, such as liver metastasis without knowledge of the primary tumor[ 20 , 45 ]. Additionally, the advantages of OATP-based probes are fewer for MHCC exhibiting tumor sizes of < 1 cm[ 8 , 20 , 46 ]. The double-antibody labeled MRI probes used in the present study allowed for the direct recognition of multiple tumor biomarkers to enhance detection specificity and sensitivity, and has the potential to improve the diagnostic performance for HCC.…”

Detecting GPC3-Expressing Hepatocellular Carcinoma with L5 Peptide-Guided Pretargeting Approach: In Vitro and In Vivo MR Imaging Experiments

“…Also, the difference of OATP expression is just about 60% between normal hepatocytes and HCC cells and dependent on the liver function, which may further compromise the diagnostic performance of MR imaging with Gd-EOB-DTPA in the setting of liver cirrhosis [ 34 ]. In addition, Gd-EOB-DTPA-enhanced MR imaging may be of limited use for the assessment of HCC nodules with diameter of less than 20 mm [ 35 ].…”

Diagnostic performance of LI-RADS for MRI and CT detection of HCC: A systematic review and diagnostic meta-analysis

“…The 18 studies comprised a total of 3386 patients (age range, 20-88 years). Three studies were prospective [17][18][19] and 14 were retrospective [20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The design of another study was unclear [34].…”

“…Nine studies enrolled subjects consecutively [17,[22][23][24]27,28,30,31,34]; the remaining nine studies did not describe how subjects were enrolled [18][19][20][21]25,26,29,32,33]. Seven studies used only histopathology as a reference standard [20,[26][27][28]30,33,34] and 11 studies used both histopathology and follow-up imaging as the reference standard [17][18][19][21][22][23][24][25]29,31,32]. Ten studies had fewer than three readers [18,[20][21][22][23][24][25][26]28,32], while eight studies had three or more readers [17,19,27,…”

“…Seven studies used only histopathology as a reference standard [20,[26][27][28]30,33,34] and 11 studies used both histopathology and follow-up imaging as the reference standard [17][18][19][21][22][23][24][25]29,31,32]. Ten studies had fewer than three readers [18,[20][21][22][23][24][25][26]28,32], while eight studies had three or more readers [17,19,27,[29][30][31]33,34]. Fifteen studies indicated that the readers were blinded and three studies provided no information on blinding [22,23,26].…”