title: Hypervascular hepatocellular carcinoma: Combined dynamic MDCT and SPIO-enhanced MRI versus combined CTHA and CTAP.
abstract: OBJECTIVE
  Recently, many diagnostic modalities have been developed for the detection of hepatocellular carcinoma (HCC). Of these, a less invasive and more accurate diagnostic procedure is desirable. This study was undertaken to compare combined dynamic multidetector row helical computerized tomography (MDCT) and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) with combined CT hepatic arteriography (CTHA) and CT during arterial portography (CTAP) for the detection of hypervascular HCC.
  
  
  METHODS
  Forty-eight patients with 56 pathologically proved hypervascular HCCs (less than 5.0 cm in diameter) underwent dynamic MDCT and SPIO-enhanced MRI, as well as CTHA and CTAP. The images were reviewed by four independent and blinded readers on a tumor-by-tumor basis.
  
  
  RESULTS
  The mean areas under alternative-free response receiver operating characteristic curve (Az) for combined dynamic MDCT and SPIO-enhanced MRI (IV set) and combinedCTHA and CTAP (IA set) were comparable (0.948 and 0.969, respectively, P > 0.05), although the Az value of the IV set was significantly lower than that of the IA set in HCCs smaller than or equal to 1.5 cm (0.867 and 0.937, respectively, P = 0.033). The mean sensitivity and positive predictive value of the IV set were similar to those of the IA set.
  
  
  CONCLUSIONS
  Combined dynamic MDCT and SPIO-enhanced MRI showed a diagnostic accuracy comparable to intra-arterial contrast-enhanced CT (CTHA and CTAP) for hypervascular HCC, and may be a useful diagnostic option prior to curative treatments of hypervascular HCC, although a limitation exists in detecting HCCs smaller than or equal to 1.5 cm.
authors.affiliation: Department of Gastroenterology, Ikeda Municipal Hospital, Osaka, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Imai
authors.forename: Takamichi
authors.initials: T
authors.lastname: Murakami
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hori
authors.forename: Kazuto
authors.initials: K
authors.lastname: Fukuda
authors.forename: Tonsok
authors.initials: T
authors.lastname: Kim
authors.forename: Taro
authors.initials: T
authors.lastname: Marukawa
authors.forename: Hisashi
authors.initials: H
authors.lastname: Abe
authors.forename: Masatomo
authors.initials: M
authors.lastname: Kuwabara
authors.forename: Hiromitu
authors.initials: H
authors.lastname: Onishi
authors.forename: Kyo
authors.initials: K
authors.lastname: Tsuda
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sawai
authors.forename: Masanori
authors.initials: M
authors.lastname: Kurokawa
authors.forename: Norio
authors.initials: N
authors.lastname: Hayashi
authors.forename: Morito
authors.initials: M
authors.lastname: Monden
authors.forename: Hironobu
authors.initials: H
authors.lastname: Nakamura