Gadoxetic acid-enhanced MRI for differentiating hepatic sclerosing hemangioma from malignant tumor

Background: To investigate the imaging features of gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate hepatic sclerosing hemangioma from malignant tumors.

Methods: This retrospective case-control study included 18 patients with sclerosing hemangioma and 54 patients with common hepatic malignant tumor, including hepatocellular carcinoma, metastatic adenocarcinoma, and cholangiocarcinoma, who were examined using gadoxetic acid-enhanced liver MRI from January 2008 to June 2019. Imaging features including signal intensity, tumor margins, enhancement pattern, and presence or absence of diffusion restriction were analyzed. Significant MRI features for predicting sclerosing hemangioma were identified using multivariable logistic regression analysis. Diagnostic performances of each imaging feature and combinations of significant imaging features were summarized.

Results: In the multivariable analysis, irregular margins (odds ratio [OR], 10.12; 95 % confidence interval [CI], 1.27-80.94; p = 0.029), centripetal or internal nodular enhancement in the transitional phase (OR, 13.58; 95 % CI, 1.48-124.82; p = 0.021), and absence of diffusion restriction (OR, 39.20; 95 % CI, 4.82-318.49; p = 0.001) were significant imaging features for the diagnosis of sclerosing hemangioma. Presence of at least two significant imaging features had a sensitivity, specificity, and accuracy of 88.9 %, 96.3 %, and 94.4 %, respectively, for diagnosing sclerosing hemangioma.

Conclusion: Combinations of two or more of the significant imaging features (irregular margins, centripetal or internal nodular enhancement in the transitional phase, and absence of diffusion restriction) were effective for differentiating hepatic sclerosing hemangioma from malignant tumors using gadoxetic acid-enhanced MRI.