Small (<or=3 cm) hepatocellular carcinoma in cirrhosis: the role of double contrast agents in MR imaging vs. multidetector-row CT.
OBJECTIVE
We prospectively compared gadoliniumenhanced magnetic resonance imaging (dynamic MRI), superparamagnetic iron oxide (SPIO) (ferucarbotran) MRI and multidetector-row computed tomography (MDCT) and the combination of dynamic MRI plus MDCT vs. dynamic MRI plus SPIO-MRI (double-contrast MRI: DC-MRI) for the detection of small (<or=3 cm) hepatocellular carcinomas (HCCs).


METHODS
Sixty-three patients with liver cirrhosis and suspicious nodules detected during ultrasound (US) surveillance underwent DC-MRI in the same imaging session and MDCT within 15 days. The final diagnosis was established at pathology on the explanted liver (n=10), resection (n=6) and biopsy (n=38) specimens or at 2-years' follow-up (n=9).


RESULTS
One hundred and twenty-three nodules were detected: 87 were confirmed HCCs in 54 patients. The accuracy of SPIO-MRI and dynamic MRI were similar, both being superior to MDCT. Dynamic MRI demonstrated the highest sensitivity (83.9%; p<0.001). especially for lesions <1 cm (90.6%) - coupled with a lower specificity (36.1%) than SPIO-MRI, particularly in subcentimeter lesions (28.6%). SPIO-MRI demonstrated the highest sensitivity for nodules >1 cm and the highest specificity (83.3%) superior to dynamic MRI (p<0.0001). In the per-lesion analysis, SPIO-MRI demonstrated a positive predictive value higher than dynamic MRI (p=0.0059) and than both the combinations dynamic MRI/MDCT and DC-MRI (p=0.0021 and p=0.0087, respectively). DC-MRI showed the highest sensitivity (97.7%) and accuracy (78.9%), detecting hypovascular and atypical HCCs >1 cm. Furthermore its per-patient negative predictive value was the highest (100%), and significantly higher than all the other methods.


CONCLUSIONS
DC-MRI is the most sensitive and accurate method and can be confidently used as a single-step procedure for the detection of small HCCs, with the exception of lesions <1 cm.
Golfieri
R
R
Radiologia Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Università di Bologna, Via Albertoni 15, 40138, Bologna, Italy. Rita.golfieri@aosp.bo.it
Marini
E
E
Bazzocchi
A
A
Fusco
F
F
Trevisani
F
F
Sama
C
C
Mazzella
G
G
Cavuto
S
S
Piscaglia
F
F
Bolondi
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003287:Contrast Media; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; C065507:ferumoxides; D019786:Gadolinium DTPA; D052203:Ferrosoferric Oxide
N Engl J Med. 1978 Oct 26;299(17):926-30
692598
Hepatology. 2008 Jan;47(1):97-104
18069697
J Comput Assist Tomogr. 2001 May-Jun;25(3):327-36
11351179
Hepatology. 2005 Jul;42(1):27-34
15954118
Radiographics. 2008 May-Jun;28(3):747-69
18480482
Liver Transpl. 2004 Feb;10(2 Suppl 1):S3-8
14762831
AJR Am J Roentgenol. 1999 Jun;172(6):1547-54
10350287
J Hepatol. 2001 Sep;35(3):421-30
11592607
Hepatology. 2003 Oct;38(4):1034-42
14512891
Radiology. 2001 May;219(2):445-54
11323471
Hepatology. 2000 Aug;32(2):205-12
10915725
Radiology. 2005 Nov;237(2):520-8
16192317
Radiology. 1997 May;203(2):449-56
9114103
Radiology. 2002 Jan;222(1):73-80
11756708
AJR Am J Roentgenol. 2000 Dec;175(6):1653-8
11090399
Radiology. 2006 May;239(2):438-47
16641353
Radiology. 2002 Mar;222(3):661-6
11867782
Hepatology. 1996 Oct;24(4):807-12
8855180
Radiology. 2000 Jul;216(1):154-62
10887242
Radiol Med. 2006 Dec;111(8):1087-102
17171525
AJR Am J Roentgenol. 2005 Apr;184(4):1069-76
15788575
Eur Radiol. 2003 Feb;13(2):262-72
12598989
Radiology. 2001 Sep;220(3):669-76
11526265
Am J Gastroenterol. 2006 Mar;101(3):513-23
16542288
Radiology. 2008 May;247(2):311-30
18430871
Liver Transpl. 2005 Mar;11(3):281-9
15719410
Dig Dis Sci. 2005 Mar;50(3):533-7
15810637
AJR Am J Roentgenol. 2003 Mar;180(3):577-84
12591657
Liver Transpl. 2002 Dec;8(12):1156-64
12474156
J Magn Reson Imaging. 2006 Jan;23(1):17-22
16315209
AJR Am J Roentgenol. 2008 Jan;190(1):47-57
18094293
Radiology. 2003 Jan;226(1):79-85
12511672
Radiology. 2005 Dec;237(3):938-44
16306035
Eur J Gastroenterol Hepatol. 2002 Feb;14(2):159-65
11981340
Radiology. 2003 Sep;228(3):719-26
12881583
J Magn Reson Imaging. 2008 Jun;27(6):1322-6
18504744
Eur Radiol. 2005 Jan;15(1):140-7
15449000
Eur Radiol. 2005 May;15(5):895-903
15800773
AJR Am J Roentgenol. 2002 Jun;178(6):1327-34
12034592
AJR Am J Roentgenol. 2001 Feb;176(2):475-82
11159099
Ann Intern Med. 2003 Jan 7;138(1):W1-12
12513067
AJR Am J Roentgenol. 2002 Oct;179(4):1045-51
12239063
J Gastroenterol. 2000;35(11):849-55
11085494
Eur Radiol. 2007 Oct;17(10):2519-30
17429640
Radiology. 2006 Feb;238(2):531-41
16371577
Hepatology. 2005 Nov;42(5):1208-36
16250051
Eur J Radiol. 2006 May;58(2):200-16
16414230
Radiology. 2003 Feb;226(2):550-5
12563153