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Value of gadoxetic acid‐enhanced MRI and diffusion‐weighted imaging in the differentiation of hypervascular hyperplastic nodule from small (<3 cm) hypervascular hepatocellular carcinoma in patients with alcoholic liver cirrhosis: A retrospective case–control study
Author(s) -
Kim Seung Soo,
Kim Seong Hyun,
Song Kyoung Doo,
Choi SeoYoun,
Heo Nam Hun
Publication year - 2020
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.26768
Subject(s) - gadoxetic acid , medicine , hepatocellular carcinoma , cirrhosis , diffusion mri , effective diffusion coefficient , radiology , magnetic resonance imaging , nuclear medicine , focal nodular hyperplasia , lesion , population , pathology , gastroenterology , gadolinium dtpa , environmental health
Background Hypervascular hyperplastic nodules (HHNs) occasionally develop in patients with alcoholic liver cirrhosis (ALC) and show arterial enhancement, thus mimicking hepatocellular carcinoma (HCC). Importantly, HHN as a benign lesion should be distinguished from HCC. Purpose To evaluate the value of gadoxetic acid‐enhanced MRI (Gd‐EOB‐MRI) and diffusion‐weighted imaging (DWI) in distinguishing HHN from small (<3 cm) hypervascular HCC (hHCC) in patients with ALC. Study Type Retrospective case–control study. Field Strength/Sequence 3.0T/in‐ and out‐of‐phase, T 1 ‐weighted, T 2 ‐weighted, diffusion‐weighted, apparent diffusion coefficient, and dynamic gadoxetic acid‐enhanced images. Population Among 560 patients with ALC who underwent Gd‐EOB‐MRI and DWI, 12 patients with 28 HHNs and 22 patients with 29 hHCCs smaller than 3 cm were included. Assessment The following MRI features were evaluated by three independent radiologists: signal intensity (SI) on T 1 ‐weighted, T 2 ‐weighted, diffusion‐weighted, and hepatobiliary phase (HBP) images; shape, homogeneity, and margin on HBP; diffusion restriction; intralesional fat; necrosis; hemorrhage; washout on portal venous phase (PVP) and/or transitional phase (TP); and capsular enhancement. Quantitative analysis was also conducted. Statistical Tests Univariate and multivariate analyses were performed to determine the significant MRI findings, and their diagnostic performance for the prediction of HHN was analyzed. Results Lesion size of ≤16 mm (odds ratio [OR], 24.41; P = 0.007), low‐to‐iso SI on DWI (OR, 26.92; P = 0.007), and absence of washout on PVP and/or TP (OR, 31.84; P = 0.009) were significant independent factors for predicting HHN. When all three criteria were satisfied, the specificity was 100%. Compared with hHCCs, HHNs showed significantly smaller size (mean, 13.8 mm vs. 19.9 mm; P < 0.001) and higher mean SI value (994.0 vs. 669.5) and lesion‐to‐liver SI ratio (1.045 vs. 0.806) on HBP ( P < 0.001, respectively). Data Conclusion Gd‐EOB‐MRI and DWI may be helpful in differentiating HHN from small hHCC in patients with ALC. Level of Evidence: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:70–80.