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MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: An explant correlation
Author(s) -
Burrel Marta,
Llovet Josep M.,
Ayuso Carmen,
Iglesias Carmela,
Sala Margarita,
Miquel Rosa,
Caralt Teresa,
Ayuso Juan Ramon,
Solé Manel,
Sanchez Marcelo,
Brú Concepció,
Bruix Jordi
Publication year - 2003
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840380430
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , radiology , nodule (geology) , nuclear medicine , magnetic resonance imaging , transplantation , angiography , paleontology , biology
Helical computerized tomography (CT) and magnetic resonance imaging (MRI) are used for staging of hepatocellular carcinoma (HCC) prior to curative treatments but underestimate tumor extension in 30% to 50% of cases when compared with pathologic explants. This study compares a new technology, MRI angiography (MRA), with triphasic helical CT in detection of HCC. Fifty cirrhotic patients, 29 with HCC, undergoing liver transplantation were analyzed. MRA was performed with a 3‐D breath‐hold fast spoiled gradient‐echo sequence by using an effective section thickness of 2 to 2.5 mm. The gold standard was the pathologic examination (liver cut into 5‐mm slices). One hundred twenty‐seven lesions were identified at the explant: 76 HCC, 13 high‐grade dysplastic nodules, 31 macroregenerative nodules, 7 hemangiomas. Diameter of the main HCC nodules was 29 ± 14 mm and 11 ± 7 mm for the 47 additional nodules. On a per nodule basis, sensitivity of MRA was superior to CT (58/76 [76%] vs. 43/70 [61%], respectively, P = .001). Sensitivity of MRA for detection of additional nodules decreased with size (>20 mm: 6/6 [100%]; 10–20 mm: 16/19 [84%]; <10 mm: 7/22 [32%]) and was superior to CT for nodules 10 to 20 mm (84% vs. 47%, P = .016). Nonspecific hypervascular nodules >5 mm at MRA were HCC in two thirds of the cases. In conclusion, MRA has a high diagnostic accuracy for HCC ⩾ 10 mm and is more sensitive than triphasic helical CT in nodules sized 10 to 20 mm. MRA is the optimal technique for HCC staging prior to curative therapies. (Hepatology 2003;38:1034–1042).