The utility of gadoxetic acid-enhanced MR imaging to characterize atypical cirrhotic nodules detected on dynamic CT images

Chen-Te Chou; Wen-Pei Wu; Chia-Bang Chen; Wei-Wen Su; Ran-Chou Chen; Yao-Li Chen

doi:10.1371/journal.pone.0107869

The utility of gadoxetic acid-enhanced MR imaging to characterize atypical cirrhotic nodules detected on dynamic CT images

PLoS One. 2014 Oct 13;9(10):e107869. doi: 10.1371/journal.pone.0107869. eCollection 2014.

Authors

Chen-Te Chou¹, Wen-Pei Wu², Chia-Bang Chen³, Wei-Wen Su⁴, Ran-Chou Chen⁵, Yao-Li Chen⁶

Affiliations

¹ Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan; Department of Radiology, Chang-Hua Christian Hospital, Changhua, Taiwan.
² Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan.
³ Department of Radiology, Chang-Hua Christian Hospital, Changhua, Taiwan.
⁴ Department of Gastroenterology, Chang-Hua Christian Hospital, Changhua, Taiwan.
⁵ Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan; Department of Radiology, Taipei City Hospital, Taipei, Taiwan.
⁶ Transplantation Medicine and Surgery Research Centre, Chang-Hua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Abstract

Purpose: To evaluate whether gadoxetic acid (Gd-EOB-DTPA)-enhanced MR images of tumors taken during the hepatocyte-specific phase can aid in the differentiation between hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) in patients with atypical cirrhotic nodules detected on dynamic CT images.

Materials and methods: Seventy-one patients with 112 nodules showing atypical dynamic enhancement on CT images underwent gadoxetic acid-enhanced MR imaging (MRI) studies. Using a reference standard, we determined that 33 of the nodules were DNs and that 79 were true HCCs. Tumor size, signal intensity on precontrast T1-weighted images (T1WI) and T2WI, and the pattern of dynamic enhancement on MR images taken in the hepatocyte-phase were determined.

Results: There were significant differences in tumor size, hyperintensity on T2WI, hypointensity on T1WI, typical HCC enhancement pattern on dynamic MR images, or hypointensity on hepatocyte-phase images between DNs and HCC. The sensitivity and specificity were 60.8% and 87.9% for T2WI, 38.0% and 87.9% for T1WI, 17.7% and 100% for dynamic MR imaging, 83.5% and 84.9% for hepatocyte-phase imaging, and 60.8% and 87.9% for tumor size (threshold of 1.7 cm).

Conclusion: Gd-EOB-DTPA-enhanced hepatocyte-phase imaging is recommended for patients at high risk of HCC who present with atypical lesions on dynamic CT images.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Carcinoma, Hepatocellular / pathology*
Diagnosis, Differential
Female
Gadolinium DTPA*
Humans
Image Enhancement / methods*
Liver Cirrhosis / pathology*
Liver Neoplasms / pathology*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Sensitivity and Specificity

Substances

gadolinium ethoxybenzyl DTPA
Gadolinium DTPA

Grants and funding

The authors thank the National Science Council, Taiwan (100-2314-B-010 -012 -MY2) and the Chang-hua Christian Hospital, Taiwan (101-CCH-IRP-03) for financially supporting this research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.