title: Hepatocellular carcinoma in the cirrhotic liver: double-contrast MR imaging for diagnosis.
abstract: OBJECTIVE
  To measure the sensitivity and accuracy of double-contrast magnetic resonance (MR) imaging for the diagnosis of hepatocellular carcinoma (HCC) in the cirrhotic liver.
  
  
  METHODS
  Twenty-seven patients with MR features of dysplastic nodules and/or HCC were examined. T2-weighted spin-echo and T1-weighted gradient-echo imaging was performed before and after superparamagnetic iron oxide (SPIO) administration and immediately followed by T1-weighted gradient-echo imaging at 10, 40, and 120 seconds after bolus injection of a gadolinium-based contrast material. Nonenhanced, nonenhanced plus SPIO-enhanced, and nonenhanced plus SPIO-enhanced plus gadolinium-enhanced images were reviewed. Alternative-free response receiver operating characteristic (ROC) methodology was used to analyze the results, which were correlated with histopathologic findings after transplantation in 15 patients and at biopsy in 12. Lesions visualized with all three techniques were characterized as a dysplastic nodule or HCC, and ROC analysis was performed.
  
  
  RESULTS
  For all observers, SPIO-enhanced MR imaging (mean accuracy, 0.76) was more accurate than nonenhanced MR imaging (mean accuracy, 0.64) (P <.04), and double-contrast MR imaging (mean accuracy, 0.86) was more accurate than SPIO-enhanced imaging (P <.05). Both types of lesions were correctly characterized with all three techniques, although observer confidence for lesion characterization was greatest with double-contrast MR imaging.
  
  
  CONCLUSIONS
  Double-contrast MR imaging significantly improves the diagnosis of HCC compared with SPIO-enhanced and nonenhanced imaging (P <.01).
authors.affiliation: Department of Radiology, MRI Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom. janice.Ward@gw.sjsuh.northy.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Ward
authors.forename: J A
authors.initials: JA
authors.lastname: Guthrie
authors.forename: D J
authors.initials: DJ
authors.lastname: Scott
authors.forename: J
authors.initials: J
authors.lastname: Atchley
authors.forename: D
authors.initials: D
authors.lastname: Wilson
authors.forename: M H
authors.initials: MH
authors.lastname: Davies
authors.forename: J I
authors.initials: JI
authors.lastname: Wyatt
authors.forename: P J
authors.initials: PJ
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis*; D003287:Contrast Media; D005260:Female; D052203:Ferrosoferric Oxide; D005682:Gadolinium; D006801:Humans; D007501:Iron; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010087:Oxides; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D010087:Oxides; D005682:Gadolinium; D007501:Iron; D052203:Ferrosoferric Oxide