Hepatocellular carcinoma in patients with chronic liver disease: comparison of SPIO-enhanced MR imaging and 16-detector row CT.
OBJECTIVE
To compare the sensitivity, positive predictive value, and diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging with those of 16-detector row computed tomography (CT) for the detection of hepatocellular carcinoma (HCC) in patients with hepatitis B-induced cirrhosis.


METHODS
Institutional Review Board approval was obtained for this study, and informed consent was obtained from all patients. A total of 44 patients (36 men, eight women; age range, 35-67 years) with 59 HCCs and mild liver cirrhosis (Child-Pugh score A or B) underwent multiphasic CT and SPIO-enhanced MR imaging. The diagnosis of HCC was established at surgical resection (n = 31) and percutaneous biopsy (n = 28). SPIO-enhanced MR imaging was composed of T2-weighted turbo spin-echo and T2*-weighted gradient-echo sequences. Multiphasic CT consisted of four phases (ie, early arterial, late arterial, portal venous, and equilibrium). Three observers independently analyzed each image in random order. Sensitivity, positive predictive value, and diagnostic accuracy were calculated by using the alternative free-response receiver operating characteristic analysis for multi-detector row CT and SPIO-enhanced MR imaging.


RESULTS
Although not significant (P > .05), the area under the receiver operating characteristic curve for SPIO-enhanced MR imaging (mean, 0.90) was higher than that for multi-detector row CT (mean, 0.82) for all observers. Also, although no significant difference was demonstrated by any of the three observers (P > .05), there was a trend toward increased sensitivity on both a per-lesion and a per-patient basis for SPIO-enhanced MR imaging (mean, 84.7% and 94.7%, respectively) compared with multi-detector row CT (mean, 76.9% and 88.6%, respectively). No significant difference in positive predictive value was observed between modalities.


CONCLUSIONS
SPIO-enhanced MR imaging and multiphasic CT show similar diagnostic accuracy, sensitivity, and positive predictive value for the detection of HCC in patients with relatively mild hepatitis B-induced cirrhosis.
Kim
Young Kon
YK
Department of Diagnostic Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Kwak
Hyo Sung
HS
Kim
Chong Soo
CS
Chung
Gyung Ho
GH
Han
Young Min
YM
Lee
Jeong Min
JM
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis*; D003287:Contrast Media; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D007501:Iron; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D007501:Iron; C065507:ferumoxides; D052203:Ferrosoferric Oxide