Double-contrast MRI for accurate staging of hepatocellular carcinoma in patients with cirrhosis.
OBJECTIVE
The aim of this study was to evaluate the accuracy of a double-contrast MRI protocol in staging of hepatocellular carcinoma (HCC) in patients with cirrhosis.


METHODS
This cross-sectional study was performed at a tertiary liver care center. Forty-eight patients with cirrhosis underwent double-contrast MRI for clinical care and liver transplantation. For each MRI examination, superparamagnetic iron oxide was infused, and 2D T2*-weighted spoiled gradient-recalled echo and T2-weighted echo-train spin-echo MR images were obtained for assessment of phagocytic function. Immediately afterward, a low-molecular-weight gadolinium compound was injected, and 3D T1-weighted spoiled gradient-recalled echo images were acquired dynamically for assessment of vascularity. Two blinded radiologists independently reviewed all MR images and assigned per-lesion and per-patient cancer confidence scores to determine the American Liver Tumor Study Group tumor stage. The imaging-based cancer scores and tumor stages were correlated with pathology reports. Performance parameters were computed for imaging-based measurements.


RESULTS
Of the 48 study subjects, 25 had HCC (three, T1; 18, T2; one, T3; one, T4a; two, T4b). In total, there were 37 HCC nodules. The accuracy of MRI in prediction of pathologic tumor stage was 81-85% depending on the radiologist. Per-patient and per-lesion sensitivity in the diagnosis of HCC were 96% and 81% for one radiologist and 96% and 89% for the other.


CONCLUSIONS
A double-contrast MRI protocol has high accuracy in staging of HCC in patients with cirrhosis.
Hanna
Robert F
RF
Department of Radiology, Division of Body Imaging, University of California, San Diego, 200 W Arbor Dr., San Diego, CA 92103-8756, USA.
Kased
Norbert
N
Kwan
Sharon W
SW
Gamst
Anthony C
AC
Santosa
Agnes C
AC
Hassanein
Tarek
T
Sirlin
Claude B
CB
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology*; D003287:Contrast Media / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media; D005290:Ferric Compounds; C000499:ferric oxide; D019786:Gadolinium DTPA