Predictors of Dysplastic Nodule Diagnosis in Patients With Liver Cirrhosis on Unenhanced and Gadobenate Dimeglumine–Enhanced MRI With Dynamic and Hepatobiliary Phase

Abstract

The combination of nodule appearance on T2-weighted MRI and nodule enhancement after gadobenate dimeglumine injection may predict dysplastic nodule diagnosis in patients with liver cirrhosis.

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

“…But when dealing with nodule-in-nodule baseline architecture with overlapped TACE treatment, more parameters that might influence the imaging aspects should be considered. For instance, the overall T1 WI hyperintensity of the background nodule, combined with the potential T1 hyperintensity of post interventional necrosis may obscure the arterial flash of the HCC foci, and may also impede the interpretation of tumor wash-out in the portal phase [32]. Another factor is the frequent appearance of pseudolesions, which mimic HCC foci; distinguishing the two is often challenging, and sometimes impossible by imaging alone.…”

Magnetic Resonance Imaging Diagnosis of Hepatocellular Carcinoma in Cirrhotic Patients: Where Are We Now?

“…This example illustrates the contribution of DWI to improve the sensitivity for the diagnosis of HCC. 6 however, it can be also seen in HGDNs and arterio-portal shunts. The diagnosis of HCC on the basis of the typical enhancement criteria of arterial hyper-enhancement and venous washout is highly sensitive and specific particularly for tumors greater than 20 mm.…”

“…The diagnosis of HCC on the basis of the typical enhancement criteria of arterial hyper-enhancement and venous washout is highly sensitive and specific particularly for tumors greater than 20 mm. 6,7 The sensitivity decreases for HCCs smaller than 20 mm as small HCCs tend to be hypervascular but not show washout on delayed images. 8,9 In one series of 60 HCCs, smaller than 20 mm, 85% of these lesions were hypervascular, and only 61.7% of which showed washout.…”

“…Intratumoral lipid is relatively uncommon (sensitivity for HCC of 12-37%), 6,10 and is more frequently present in the form of intracellular lipid, which may be identified with chemical shift imaging. As a rule, any lipid-containing tumor in a cirrhotic liver should be viewed with suspicion, especially when the lesion diameter is > 15 mm.…”

“…One study reported increased specificity in hypervascular nodules when combined with increased T2 signal up to 95%. 6 Recent studies have shown that the addition of T2 weighted imaging to gadolinium-enhanced MR imaging improves the diagnostic performance in the detection of HCC compared to isolated DCE-MRI. This is particularly true for HCCs smaller than 10 or 20 mm, which may show hypervascularity, but might not show washout, discriminating them from HGDNs.…”